32906 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 SENATE—Monday, December 21, 2009

(Legislative day of Sunday, December 20, 2009)

The Senate met at 12:01 a.m., on the SERVICE MEMBERS HOME OWNER- mented, will cost about $2.5 trillion expiration of the recess, and was called SHIP TAX ACT OF 2009—Resumed over 10 years, according to the Senate to order by the Honorable MARK Pending: Budget Committee; which restructures UDALL, a Senator from the State of Reid amendment No. 2786, in the nature of a sixth of our economy; which affects Colorado. a substitute. 300 million people; which will raise taxes by about $1 trillion when fully PRAYER Reid amendment No. 3276 (to amendment No. 2786), of a perfecting nature. implemented over 10 years; and which The Chaplain, Dr. Barry C. Black, of- Reid amendment No. 3277 (to amendment will cut Medicare by about $1 trillion fered the following prayer: No. 3276), to change the enactment date. when fully implemented over 10 years. Let us pray. Reid amendment No. 3278 (to the language It doesn’t cut Medicare to make Medi- Eternal God, help of the ages, as we proposed to be stricken by amendment No. 2786), to change the enactment date. care more solvent which, as we know, labor a great while before day, give our Reid amendment No. 3279 (to amendment it is going to become insolvent, accord- lawmakers the wisdom to see the right No. 3278), to change the enactment date. ing to its trustees, by 2015, but to spend and the courage to do it. Cause them to Reid motion to commit the bill to the on a new entitlement. be men and women of integrity, so that Committee on Finance, with instructions to It will also shift to the States a great our citizens can lead quiet and peaceful report back forthwith, with Reid amendment many expenses, so much so that our lives in all godliness and honesty. Re- No. 3280, to change the enactment date. Democratic Governor in Tennessee has mind our Senators that You have Reid amendment No. 3281 (to the instruc- said it is the mother of all unfunded tions (amendment No. 3280) of the motion to called them to be servants of the peo- commit), to change the enactment date. mandates. The Governor of California ple during this challenging season, so Reid amendment No. 3282 (to amendment says it is the last thing we need, take that they must not succumb to pes- No. 3281), to change the enactment date. your time, get it right. But the Demo- simism and cynicism or grow weary in The ACTING PRESIDENT pro tem- cratic leader and his colleagues insist well doing. Gird them with fortitude. pore. Under the previous order, the that we need to bring this up in the Illumine them with the light of truth, time until 1 a.m. will be equally di- middle of a snowstorm, write it in se- and make them more than conquerors vided and controlled between the two cret, vote on it in the middle of the in the faith that the kingdoms of this leaders or their designees, with the ma- night, and get it passed before Christ- world are to become the one and radi- jority leader controlling the final 10 mas Eve. ant Kingdom of Your redeeming love. minutes prior to 1 a.m., and the Repub- Why would they want to do that? Lord, please remind the many work- lican leader controlling the 10 minutes Well, I think the answer is very clear. ers who support the legislative process immediately prior to that. It is because they want to make sure that You see their diligence and will The Senator from Tennessee. they pass it before the American people reward their faithful sacrifices. Mr. ALEXANDER. Mr. President, I find out what is in it. Because the We pray in Your great Name. Amen. intend to take 10 minutes of the Repub- American people, by nearly two to one, according to a CNN poll, do not like f lican time. Will you please let me know when 1 minute remains? what they have heard about the health care bill. When they have to start ex- PLEDGE OF ALLEGIANCE The ACTING PRESIDENT pro tem- pore. The Senator will be notified. plaining what is in it, they are afraid it The Honorable MARK UDALL led the Mr. ALEXANDER. Thank you, Mr. will be worse, and it will never pass. Pledge of Allegiance, as follows: President. Republicans are not the only ones I pledge allegiance to the Flag of the who believe we ought to stop and think United States of America, and to the Repub- Mr. President, there may be a num- ber of Americans who are switching about big issues before we deal with it. lic for which it stands, one nation under God, Eight Democratic Senators—Senators indivisible, with liberty and justice for all. over from the Minnesota v. Carolina football game and they may be won- LINCOLN, BAYH, LANDRIEU, LIEBERMAN, f dering what in the world is the U.S. MCCASKILL, NELSON, PRYOR, and Senate doing coming into session at WEBB—wrote Senator REID on October APPOINTMENT OF ACTING 6, saying to Senator REID: PRESIDENT PRO TEMPORE midnight on a Sunday in the middle of a snowstorm and getting ready to vote As you know, Americans across our coun- The PRESIDING OFFICER. The at 1 a.m.? So let me try to explain that try have been actively engaged in the debate on health care reform. . . . Without a doubt, clerk will please read a communication for a moment. to the Senate from the President pro reforming health care in America is one of The reason is, the Democratic major- the most monumental and far-reaching un- tempore (Mr. BYRD). ity leader, who is the only one who can dertakings considered by this body in dec- The legislative clerk read the fol- set our schedule, showed up yesterday ades. We believe the American public’s par- lowing letter: with a 400-page amendment—yester- ticipation in this process is critical to our U.S. SENATE, day. This amendment had been written overall success.... PRESIDENT PRO TEMPORE, in secret for the last 6 weeks. The as- I am quoting from the eight Demo- Washington, DC, December 21, 2009. sistant Democratic leader said, last cratic Senators. They go on to say they To the Senate: want to make sure the bill is on a Web Under the provisions of rule I, paragraph 3, week, on the floor, he had no idea what of the Standing Rules of the Senate, I hereby was in it. Of course, none of us on the site ‘‘for at least 72 hours’’ before we appoint the Honorable MARK UDALL, a Sen- Republican side knew what was in it. vote on it. This bill was given to us ator from the State of Colorado, to perform So almost no one here knew what was yesterday—400 pages of it—we had not the duties of the Chair. in it. It was presented to us. Then the seen before. Seventy-two hours would ROBERT C. BYRD, Democratic leader said: Well, we are be Tuesday. So the minimum require- President pro tempore. going to start voting on it, and we are ment, according to the eight Demo- Mr. UDALL of Colorado thereupon going to pass it before Christmas. cratic Senators and all 40 Republican assumed the chair as Acting President This is an amendment to the health Senators, would be that we should not pro tempore. care bill, which when fully imple- even think about voting on it until at

● This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00001 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32907 least Tuesday. And then one would ing to the chief actuary for Medicare, The ACTING PRESIDENT pro tem- think we would be amending it and de- it will cause national health care pore. The Senator from Arizona is rec- bating it and considering it and think- spending to increase faster.’’ So if you ognized. ing about it and trying to find out are paying X for premiums, you are Mr. MCCAIN. Mr. President, as we ap- what it actually does. going to be paying more as a result of proach in less than an hour a very im- According to the eight Democratic this bill. portant vote—some have called it his- Senators: Continuing, David Brooks said: toric, some call it pivotal; it has been By publicly posting the legislation and its Health care spending is already zooming given various adjectives and adverbs—I [Congressional Budget Office] scores 72 hours past 17 percent of [our gross domestic prod- think it might be appropriate to dis- before it is brought to a vote in the Senate uct] to 22 percent and beyond. cuss for a minute or two how this all and by publishing the text of amendments began. before they are debated, our constituents Then it is going to be hard to explain will have the opportunity to evaluate these to the 9 million people who the Con- It all began in the Presidential cam- policies. . . . As their democratically-elected gressional Budget Office letter said paign. I do not like to spend much time representatives . . . it is our duty to listen would lose their employer insurance recalling it. But health care was a big . . . and to provide them with the chance to under this bill why that will happen. Of issue in the Presidential campaign. On respond to proposals that will impact their course, it will happen because under October 8, 2008, less than a month be- lives. the bill as a whole, as employers look fore the election, then-Candidate Yet, we are presented with it in the at the mandates and the costs, many Obama said, concerning health care re- middle of a snowstorm on Saturday, we will decide not to offer health insur- form: are meeting at midnight, we are voting ance, and so those employees will find I’m going to have all the negotiations at 1 a.m. It is being demanded that it themselves either in Medicaid, the pro- around a big table. . . . What we’ll do is we’ll be passed, even though most of the pro- gram for low-income Americans—into have the negotiations televised on C–SPAN, visions, as the Senator from Maine has which 15 million more Americans are so that people can see who is making argu- said, do not even begin to take effect going; a program for which 50 percent ments on behalf of their constituents and for 4 more years. who are making arguments on behalf of drug of doctors will not see new Medicaid companies— What is the rush? I think the rush is patients; it is like giving you a ticket that our friends on the other side do to a bus when the bus only runs half Keep that in mind: the drug compa- not want to explain to 40 million sen- the time—that is where many of these nies— iors how you can cut $1 trillion out of Americans will go, or they will go into or the insurance companies. Medicare—it is exactly $470 billion over the individual market, and the indi- That was the statement made by the next 10 years, but when fully imple- vidual market will have higher pre- mented $1 trillion out of Medicare—and then-Senator/Candidate Obama. What miums. we have is a dramatic departure. There spend it on a new program without re- The other side says: Ah, but there ducing Medicare services to 40 million has never been a C–SPAN camera. will be subsidies for some of you. But There has never been a negotiation, a seniors. The Director of the Congres- the premiums are going to be higher, sional Budget Office has already said serious negotiation between Repub- the health care costs are going to be licans and the other side. There has that for the 11 million seniors who are higher. on Medicare Advantage that fully half never been. I say that with the knowl- The majority does not want to ex- their benefits will be affected. edge of someone who has negotiated I think our friends on the other side plain why this bill changes the bipar- many times across the aisle on many do not want the American people to tisan agreement not to have Federal agreements. So don’t stand and say understand why the $578 billion in new funding for abortion that has been there were serious negotiations be- taxes that are going to begin to be im- agreed to since 1977. tween Republicans and Democrats. posed next year—they are going to They do not want to take time for There never were. have a hard time explaining how that the American people to understand the But there were negotiations with the will create new jobs in America, at a CLASS Act, the long term insurance special interests, with PhRMA, the time when we have 10 percent unem- act, a new entitlement which sounds same ones the President said he was ployed. New taxes? wonderful, but the Democratic chair- going to see who the American people They do not want the American peo- man of the Budget Committee de- were on the side of. Clearly, this ad- ple to find out the Director of the Con- scribed it as a Ponzi scheme worthy of ministration and that side of the aisle gressional Budget Office said that if we Bernie Madoff. That is because the was on the side of PhRMA because they put those new taxes on insurance pro- amount of money that would be paid got a sweetheart deal of about $100 bil- viders, on medical devices, almost all in, if a person pays a premium of $2,880 lion that would have been saved if we of those taxes will be passed on to the per year for 5 years, would be $14,000, had been able to reimport prescription consumers and, as a result, premiums and then they would have a $1,500 drugs. The AARP has a sweetheart will go up. monthly benefit for a long time after deal. There is a provision in this deal There are some very strong words that. for them, plans that Medigap insurance that have been coming from the other It is obvious why the majority has sold by AARP are exempt from tax on side about Republicans saying this bill cooked up this amendment in secret, insurance companies. The AMA signed will actually increase the cost of has introduced it in the middle of a up because of the promise of a doc fix. health care. It is not Republicans who snowstorm, has scheduled the Senate Throughout we should have set up a are saying that. Here is what David to come in session at midnight, has tent out in front and put Persian rugs Brooks of the New York Times said in scheduled a vote for 1 a.m., is insisting out in front of it. That is the way this his analysis of the bill when he gave it be passed before Christmas, because has been conducted. the reasons for it and the reasons they do not want the American people Of course, after the special interests against it this week and came to the to know what is in it. were taken care of, then we had to take conclusion that if he were a Senator he It is a deeply disappointing legisla- care of special Senators. One deal is would vote against it. Mr. Brooks said: tive result. But our friends on the called—we have new words in our lexi- The second reason to oppose this bill is Democratic side seem determined to con now—the Louisiana purchase, the that, according to the chief actuary for pursue a political kamikaze mission corn husker kickback. I have a new Medicare, it will cause national health care toward a historic mistake, which will name: the Florida flimflam, the one spending to increase faster. be bad for the Democrats, I am con- that gives the Medicare Advantage That is right, we are going to raise vinced, but, unfortunately, even much members in Florida the benefit, but my taxes, cut Medicare, send a big bill to worse for our country. constituents in Medicare Advantage the States—all for what? ‘‘ . . . accord- Mr. President, I yield the floor. don’t get it.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00002 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32908 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 So in answer to this, in answer to a are going to the townhalls, we are extra mile, he went the extra 100 miles question today, the majority leader going to the senior centers, we are to try to get Republicans to work with said: going to the rotary clubs. We are going him on this bill. In the end, only one A number of States are treated differently to carry this message: We will not do Republican would vote for the bill out than other States. this. We will not commit generational of committee. Really? theft on future generations of Ameri- So that is what we have. I am sorry A number of States are treated differently cans. We will not give them another to say my friends on the other side are than other States. That is what legislation is $21⁄2 trillion in debt. We will not give in total disarray. They have nothing all about. That is compromise. them an unfair policy where deals are they can agree on. Well, we have some- Where is that taught? Where is that done in back rooms, and we—all of us thing we have agreed on. Sixty, a taught? on this side of the aisle—will stand for supermajority, have agreed on moving A number of States are treated differently the American people, and we have just a bill forward, a pivotal point in our than other States. That is what legislation is begun to fight. history, in a decades-long march to- all about. That is compromise. The ACTING PRESIDENT pro tem- ward comprehensive health reform. It My friends, that is not what the pore. Who yields time? has alluded Congresses and Presidents American people call governing. That The Senator from Iowa is recognized. going back to Theodore Roosevelt. is called exactly an opposite contradic- Mr. HARKIN. Mr. President, for the My friends on the other side defend tion of what the President of the last several weeks, all we have heard the status quo. They want us to vote United States said, where he says: from the other side is attack, attack, our fears—fear, fear, fear. Everything We will have negotiations televised on C– attack. All we have heard from the you hear, it seems, on the other side is SPAN so that people can see who is making other side is no, no, no. They keep fear. Be afraid. Well, it is not going to arguments. talking. I just heard the Senator from work this time because what the Amer- I see the leader from Illinois over Arizona saying this is not a bipartisan ican people want is not fear, they want there. Just a few days ago, I said: What bill. I have heard so much talk on the hope. They want the hope they will is in the bill? other side in the last several weeks have the health care they need when The Senator from Illinois said: I about how this should be bipartisan. they have to have it at a price that is don’t know. I am in the dark too. I can Well, let’s look at that for a second. affordable. They want to have the As I see it, the Republicans have no give him his own quote. peace of mind and security of knowing So here we are, as the Senator from bill of their own. Our bill has 60 Demo- that their children, if they have a pre- Tennessee said, in the middle of the crats, a supermajority, a super- existing condition, will be covered by night, and here we are, my friends, majority. Well, I guess there is a bill health insurance. They want to have about to pass a bill with 60 votes. Sixty over there. It is the Coburn-Burr bill. the peace of mind of knowing that if votes represent 60 percent of this body, It has seven cosponsors. That is it. they lose a job, they don’t lose their but I can assure my friends on the That is it. Nothing else. Not all the Re- health insurance. The American people other side of the aisle it doesn’t rep- publicans are supporting it. My friends want the hope and the security of resent 60 percent of the American peo- on the other side are all over the place. knowing that if they get ill, they will ple. In fact, 61 percent of the American They can’t even agree among them- not be dropped by their insurance com- people, according to a CNN poll, say selves what they want to do. They have they want this stopped. They dis- no comprehensive bill as we have come pany. They want the hope and the secu- approve of it. I guarantee you, when up with. rity to know they aren’t just one ill- you go against the majority opinion of So I keep hearing that we Democrats ness away from bankruptcy. We are the only country in the the American people, you pay a heavy are not bipartisan, but whom do we world—the only one—where people can price, and you should. deal with? Just the Senator from Ari- I will tell my colleagues right now zona? Just the Senator from Ten- go bankrupt because they owe a med- that when you—this will be, if it is nessee? How about the Senator from ical bill. No other country would allow passed—and we are not going to give up Oklahoma or the Senator from South that to happen. We are the only one. after this vote, believe me. For the Carolina? So I am sorry. I feel sorry This bill is going to stop that. People first time in history, for the first time the Republicans are all split up. They will not have to fear going bankrupt in history, there will be a major reform have not done their own homework to because someone in their family got a passed on a party-line basis. Every re- pull their own Senators together for chronic illness or a disease that is form—and I have been part of them— something positive. So what they have going to cost a lot of money. The has been passed on a bipartisan basis. done is they pulled together to say no, American people want us to move for- This will be a strict party-line basis. to try to kill the reform bill we have ward, and we are going to do it tonight I was thinking today about this vote, worked so hard on all year. at 1 o’clock. We are going to move for- and I was thinking about other times We extended a hand. If we had want- ward. We are not going to vote fears, and other examples I have had of cour- ed to ace out the Republicans, we we are going to vote hope. age or lack of or the fact that in the would have followed their lead on what We are going to tell the American face of odds, you have to stand for they did in 2001, when they rammed people we are going to do three big what you believe in. I thought about through that tax cut for the wealthy. things. First of all, we are going to back when I first entered the U.S. They did it on reconciliation so we cover 94 percent of Americans with Naval Academy at the young age of 17. couldn’t filibuster it, so we couldn’t health insurance—94 percent. Thirty- One of the first things they told us have any debate on it. That is what one million people out there without about in our learning of naval tradi- they did. We didn’t do it that way. health insurance are going to get tions was about a battle that took President Obama said we want to health insurance. place early in the Revolutionary War. hold out the olive branch. We want to Secondly, we are going to crack down An American ship run by a captain en- work with Republicans, so that is what on the abuses of the insurance compa- gaged a British ship, the mighty Brit- we tried to do. Under the leadership of nies. No more cancelling your policy ish Navy. The American ship was Senator DODD on our committee, we just because you got sick. No more life- outgunned and was outmanned. As had numerous meetings with Repub- time caps which basically cause more they came together in mortal combat, licans. We had a markup session that and more people to go into bankruptcy. with dead and dying all around, the lasted 13 days 54 hours. We accepted 161 No more of those lifetime caps. We are British captain said: Do you surrender? of their amendments and, in the end, going to make sure your kids can stay The captain, John Paul Jones, said: I everyone on the Republican side voted on your policy until they are age 26. have not yet begun to fight. against it. We are going to do away with all these I tell the American people: We are Senator BAUCUS bent over backward, preexisting condition clauses next year going to go around this country. We week after week. He not only went the for children, up to age 18, and then for

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00003 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32909 everyone later on after we get the ex- had so much input. Everyone has had that last freedom that Franklin Roo- changes set up. input on this bill. Our Republican sevelt talked about in December of 1941 Insurance companies will not be able friends have had input on this bill. that is deserving of our attention in to rescind your policy or drop you be- They had it in our committee. As I these closing minutes. cause you got cancer or heart disease. said, we accepted 161 amendments. So I Whatever else one may argue about If you are a person out there who has guess you can say this bill has a lot of the specifics of this bill, it is that fear your own health insurance policy right authors. But there is really only one that so many of our fellow citizens now and you like it, you can keep it. author of this bill—Senator Ted Ken- have over whether they will be con- But guess what this bill will do. It will nedy. It is his bill because it does get fronted with a health care crisis and lower your premiums, and it will im- us the start. have the resources to address it and prove your coverage if you want to To my friends, I say this is not the the ability to have a doctor, a physi- keep your own health insurance that end of health care reform, it is the be- cian, a health care provider, a hospital you have right now. ginning. But we must make this begin- to provide them with that kind of help Every year, about 45,000 Americans ning in order to fulfill that dream and when they need it. That fear is not just die in this country because they have really make health care a right, not a for those without health care; it is no health insurance. Johns Hopkins did privilege. even for those who have health care in- a study and said that children who In half an hour, let’s make history. surance. That fear persists. have no health insurance are 60 percent The other side says fear. We say hope. This evening, more than anything more likely to die because of hos- The other side says no. We say yes. We else, beyond the specifics of the legisla- pitalizations than kids who have say yes to progress, yes to people, yes tion in front of us is our desire to ad- health insurance coverage. It is a to health care as an inalienable right dress that freedom from fear that was moral disgrace. The health insurance of every American citizen. addressed so eloquently almost 70 years policies of America, what we have right I yield the floor. ago. So this evening we attempt, any- now is a moral disgrace. You can talk Mr. CORNYN. Parliamentary in- way, to begin that journey of elimi- to people from other countries, our quiry. nating those fears so many of our fel- closest allies, our closest friends who The ACTING PRESIDENT pro tem- low citizens have over the loss or in- share so many of our values, and when pore. The Senator from Texas is recog- ability to acquire that kind of health they find out about our health care nized. insurance or the inability to have a system, they say: How can you put up Mr. CORNYN. Mr. President, earlier doctor. with it? This is disgraceful. You are today Senator GRASSLEY raised a par- So we are poised to make a monu- the leader of the free world. You are liamentary inquiry on rule XLIV of the mental vote on legislation that finally supposed to set the example. And what Standing Rules of the Senate. As my makes access to quality health care a a terrible example we have set in colleagues recall, this was a rule that right for every American. If you do not health care, what a terrible example. the Senate passed pursuant to the Hon- believe it is a right, that it is only a Well, we have finally arrived at one est Leadership and Open Government privilege, then I suppose you could of the most significant moments in the Act of 2007. The question had to do come to a different conclusion. And history of the Senate, one of the most with whether the managers’ amend- there are those, I guess, who believe it significant. Our former chairman, Sen- ment we are getting ready to vote on is a privilege to have access to health ator Ted Kennedy, fought all his life complied with rule XLIV’s earmark care as an American citizen. Those of for national health insurance, and disclosure requirement. At the time, us on this side of the aisle believe it is years ago, back in the 1960s, said the Chair indicated that the disclosure a right, and as a right, you ought not health care ought to be a right, not a list was not submitted at the time. to be denied that right based on eco- privilege. That was 6 p.m. today. nomic circumstances, your gender, or He said that over 40 years ago, al- My inquiry is this: Is the Chair aware your ethnicity in this Nation. You most 50 years ago, that health care of the disclosure list being made avail- ought to have access to health care as should be a right and not a privilege. It able as required by rule XLIV now as a fundamental right in our Nation. was always his highest priority. It was we vote in the next 30 minutes? Obviously, we need to participate, en- his great dream of an America where The ACTING PRESIDENT pro tem- gage in responsible activities that will quality, affordable health care is that pore. The Chair is not aware at this make sure we contribute to the well- right. He thought of it as a moral im- time whether that statement has been being of all our Nation to reduce the perative—a moral imperative. A lot of made. cost of health care. times, we lose that. We hear a lot of de- The Senator from Connecticut is rec- This is a comprehensive bill. It has bate about how much this is, who is ognized. been more than just a year specifically going to lose this, all these scare tac- Mr. DODD. Mr. President, I wish to on this effort but goes back 40 or 50 tics. We see all these numbers and all take a few minutes in closing, if I may. years in terms of drafting, and efforts that kind of stuff. We forget the es- I spoke earlier this evening about the have been made to achieve what we are sence of it. It is a moral imperative. importance of the moment we have all trying to achieve this evening. We are called upon to right a great in- come to appreciate, I believe, a mo- At the end of the day, however, this justice, a great wrong that has been ment that has been years in the mak- legislation is really about freedom put upon the American people for far ing, dating back, as all have pointed from fear, as I said a moment ago. The too long. It is a moral imperative that out or most have pointed out who bill frees Americans from the fear that confronts us now that we will vote on spoke in favor of this legislation, to if they lose their job, they will never in half an hour. We are closer than we the early part of the last century with find insurance coverage again. The bill have ever been to making Ted Ken- Theodore Roosevelt, a former Repub- frees Americans from the fear that nedy’s dream a reality. lican, who first advocated the notion of they might get sick and be unable to A lot of people have worked very a national health care system in our afford the treatment they need. And hard on this bill. I mentioned Senator Nation. Franklin Roosevelt picked up the bill frees Americans from the fear BAUCUS. I mentioned Senator DODD; that challenge, and Harry Truman, of that one illness, one accident could Senator REID, our leader, the amount course, was the one who articulated it cost them everything they built—their of hours he has spent and the days he in specific terms. homes, their retirement, their life sav- has spent here without his family, It was 69 years ago this very month ings. without going home, being here all the that Franklin Roosevelt identified the In a nation founded on freedom and time working; our assistant leader, four freedoms: freedom of religion, sustained by unimaginable prosperity, Senator DURBIN. So many people have freedom of speech, the freedom from as I mentioned before, this bill is long worked so hard on this bill. We have want, and the freedom from fear. It is overdue and critically important. No

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00004 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32910 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 American can be free from fear when will shape the future of our country. It and government intrusion that, in the getting sick could mean going broke. will determine whether our children end, their biggest problem wasn’t con- This fight is older than most of us can afford the Nation they inherit. It is vincing Republicans to support it, it who serve in this body. Our path has one of the most consequential votes was convincing the Democrats. been illuminated by a torch lit years any of us will ever take, and none of us In the end, the price of passing this ago in the days of Harry Truman and take it lightly. But make no mistake, bill wasn’t achieving the reforms sustained for decades by good people, if the people who wrote this bill were Americans were promised, it was a Republicans and Democrats—the Nixon proud of it, they would not be forcing blind call to make history, even if it administration, the Clinton adminis- this vote in the dead of night. was a historical mistake, which is ex- tration, Members such as John Chafee, Here are just some of the deals we actly what this bill will be if it is who worked tirelessly in trying to have noticed: $100 million for an passed. Because in the end, this debate craft a good health care bill. We heard unnamed health care facility at an isn’t about differences between two others talk about the regrets they had unnamed university somewhere in the parties, it is about a $2.3 trillion, 2,733- not acknowledging his ideas when he United States. The bill does not say page health care reform bill that does proposed them or we might have been where and no one will even step for- not reform health care, and, in fact, able to address this issue years ago. ward to claim it. Mr. President, 1 State makes the price of it go up. Good people have tried to come up with out of 50—1 State out of 50—gets to ex- ‘‘The plan I am announcing tonight,’’ some answers to this issue. It is with a pand Medicaid at no cost to itself while the President said on September 9, note of sadness this evening that we taxpayers in the other 49 States pick ‘‘will slow the growth of health care are going to have a partisan vote on up the tab. The same Senator who cut costs for our families, our businesses this matter. I wish it was otherwise. that deal secured another one that ben- and our government. My plan,’’ the I would like to point out that many efits a single insurance company—just President said, ‘‘would bring down pre- of us have fought and challenged us to one insurance company—in his State. miums by $2,500 for the typical family. come up with these answers, but to- Do the supporters of the bill know I will not sign a plan that adds a dime night this is our answer, the 60 of us this? I say to my colleagues, do you to our deficit,’’ the President said, ‘‘ei- who will vote to go forward with this think that is fair to all of your States? ther now or in the future.’’ And on bill. As Senator HARKIN just pointed What about the rest of the country? taxes, ‘‘No family making less than out, it is hardly the final answer on The fact is, a year after the debate $250,000 a year will see any form of tax this matter, but it allows us to begin started, few people would have imag- increase,’’ he said. He said he wouldn’t cut Medicare. He that process of addressing these issues ined this is how it would end—with a said people who liked the plans they in a more thoughtful and comprehen- couple of cheap deals—a couple of have wouldn’t lose their coverage, and sive way in the years ahead. cheap deals—and a rushed vote at 1 Americans were promised an open and Of course, no one was a better cham- o’clock in the morning. But that is honest debate. ‘‘That is what I will do pion of all of this, as Senator HARKIN where we are. And Americans are won- in bringing all parties together,’’ then- pointed out, than our deceased and be- dering tonight: How did this happen? Senator Obama said on the campaign loved colleague from Massachusetts, How did this happen? So I would like to trail, ‘‘not negotiating behind closed Senator Ted Kennedy. He fought these take a moment to explain to the Amer- doors, but bringing all parties together battles for so many years. He under- ican people how we got here, to explain and broadcasting these negotiations on stood that you could never solve all of what has happened and, yes, what is C–SPAN.’’ these issues in one fell swoop. It was happening now. Well, that was then and this is now. going to take an incremental approach Everyone in this Chamber agrees we But here is the reality. The Democratic to get us there. need health care reform. Everybody bill we are voting on tonight raises I can guarantee that if he read this agrees on that. The question is how. health care costs. That is not me talk- bill, there would be disappointments he Some of us have taken the view that ing, it is the administration’s own would have in it. I knew him well the American people want us to tackle budget scorekeeper. It raises pre- enough to say that this evening. If he the cost issue, and we proposed tar- miums. That is the nonpartisan Con- had written it on his own, he would geted steps to do it. Our friends on the gressional Budget Office talking. It have written it differently. Were he other side have taken the opposite ap- raises taxes on tens of millions of mid- here among us this evening, he would proach, and the result has been just dle-class Americans, and it plunders urge all of us to move forward on this what you would expect. The final prod- Medicare by $1⁄2 trillion. It forces peo- bill to address it, to vote for it, to uct is a mess—a mess. And so is the ple off the plans they have, including allow this Nation to begin to grapple process that has brought us here to millions of seniors. It allows the Fed- with this issue that should have been vote on a bill that the American people eral Government, for the first time in solved more than 50 years ago. overwhelmingly oppose. our history, to use taxpayer dollars for So this evening, again, as we come Any challenge of this size and scope abortions. down to the final minutes of this de- has always been dealt with on a bipar- So a President who was voted into of- bate, let’s remind ourselves that his- tisan basis. The senior Senator from fice on the promise of change said he tory will judge us well for taking up Maine made that point at the outset of wanted to lower premiums. That this challenge once again and asking the debate and reminded us all of how changed. He said he wouldn’t raise ourselves to give Americans the oppor- these issues have typically been han- taxes. That changed. He said he wanted tunity to live free from those fears dled throughout our history. The So- lower costs. That changed. He said he they have this very evening. And to- cial Security Act of 1935 was approved wouldn’t cut Medicare. And that night, we begin to alleviate those fears. by all but six Members of the Senate. changed too. I urge my colleagues to support this The Medicare Act of 1965 only had 21 And 12 months and $2.3 trillion later, effort. dissenters, and the Americans with lawmakers who made these same prom- I yield the floor. Disabilities Act in 1990 only had eight ises to their constituents are poised to The ACTING PRESIDENT pro tem- Senators who voted no. vote for a bill that won’t bend the cost pore. The Republican leader is recog- Americans believe that on issues of curve, that won’t make health care nized. this importance, one party should more affordable, and it will make real Mr. MCCONNELL. Mr. President, to- never be allowed to force its will on the reform even harder to achieve down the night marks the culmination of a long other half of the Nation. The pro- road. national debate. Passions have run ponents of this bill felt differently. I understand the pressure our friends high, and that is appropriate because In a departure from history, Demo- on the other side are feeling, and I the bill we are voting on tonight will cratic leaders put together a bill so don’t doubt for a moment their sin- impact the life of every American. It heavy with tax hikes, Medicare cuts, cerity. But my message tonight is this:

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00005 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32911 The impact of this vote will long out- they couldn’t afford a plan that met With this vote, we are rejecting a live this one frantic snowy weekend in their most basic needs. system in which one class of people can Washington. Mark my words: This leg- This country—the greatest and rich- afford to stay healthy while another islation will reshape our Nation, and est the world has ever seen—is the only cannot. It demands for the first time in Americans have already issued their advanced Nation on Earth where dying American history good health will not verdict: They do not want it. They do for lack of health insurance is even depend on great wealth. Good health not like this bill, and they do not like possible. To make matters worse, we should not depend on how much money lawmakers playing games with their are paying for that privilege. The price you have. It acknowledges, finally, health care to secure the votes they of staying healthy in American goes that health care is a fundamental need to pass it. up, it goes up, it goes up and, not sur- right, which my friend Senator HARKIN Let’s think about that for a moment. prisingly, so do the numbers of Ameri- spoke about so clearly—a human We know the American people are over- cans who can’t afford it. In fact, med- right—and not just a privilege for the whelmingly opposed to this bill, and ical bills are the leading cause of bank- most fortunate. yet the people who wrote it will not ruptcy in America. And the second President Johnson, former majority give the 300 million Americans whose choice is way down the list—it is med- leader of the Senate, signed Medicare lives will be profoundly affected by it ical bills. into law when he was President, with as much as 72 hours to study the de- That is why we are here. Just as we the advice: ‘‘We need to see beyond the tails. Imagine that. When we all woke have the ability to prevent diseases words to the people they touch.’’ That up yesterday morning, we still hadn’t from killing us too soon, we have be- is just as true today as it was 44 years seen the details of the bill we are being fore us the ability to provide quality ago when he signed that legislation. asked to vote on before we go to sleep health care to every American. We This is not about partisanship or tonight. have the ability to treat our unhealthy about procedure. And everyone knows When we woke up yesterday morning, health care system. That is what this we are here at 1 o’clock in the morning we still hadn’t seen the details of the historic bill does. It protects patients because of my friends on the other side bill we are going to be asked to vote on and consumers. It lowers the cost of of the aisle. For them to say with a before we go to sleep tonight. staying healthy and greatly reduces straight face—and I know some of How can anybody justify this ap- our debt. them didn’t have that straight face— proach, particularly in the face of such This landmark legislation protects that we are here because of us is with- America’s youngest citizens by making widespread and intense public opposi- out any foundation whatsoever. And it illegal for insurance companies to tion? Can all of these Americans be everyone knows that. refuse to cover a child because of a pre- This is not about politics. It cer- wrong? Don’t their concerns count? existing condition. tainly is not about polling. It is about Party loyalty can be a powerful It protects America’s oldest citizens people. It is about life and death in force. We all know that. But Americans by strengthening Medicare and extend- America. It is about human suffering. are asking the Democrats to put party ing its life for almost a decade. We are Given the chance to relieve the suf- loyalty aside tonight, to put the inter- also taking the first steps to closing fering, we must. est of small business owners, tax- the notorious loophole known as the Citizens in each of our States have payers, and seniors first. doughnut hole that costs seniors thou- written to tell us they are broke be- And there is good news: It is not too sands of dollars each year for prescrip- cause of our broken health care sys- late. All it takes is one—just one. All it tion drugs. These are some of the rea- tem. Some have sent letters with even takes is one. One can stop it. One can sons the AARP—the American Associa- worse news—news of grave illness and stop it or everyone will own it. One can tion of Retired People—and its 40 mil- preventable death. For weeks, we have stop it or every single one will own it. lion Americans are supporting this bill. heard opponents complain about the My colleagues, it is not too late. Contrary to what we heard from my number of pages in this bill, but I pre- The ACTING PRESIDENT pro tem- distinguished friend, the Republican fer to think of this bill in terms of the pore. The majority leader is recog- leader, premiums are reduced by 93 per- people it will help. nized. cent. Ninety-three percent of people A woman named Lisa Vocelka, who Mr. REID. Mr. President, all over who have insurance will have reduced lives in Gardnerville, NV—a beautiful this great country of ours, people are premiums. city below the Sierra Nevada moun- dying soon—far too soon. More and This effort also strengthens our fu- tains—lives with her two daughters, more Americans who come down with ture by cutting our towering national both of whom are in elementary school. the flu, develop diabetes, or suffer a deficit by as much as $1.3 trillion over The youngest suffers seizures. Her stroke are dying far earlier than mod- the next two decades. What my distin- teachers now think she has a learning ern science says they should die. More guished Republican counterpart is say- disability. and more Americans who contract skin ing is without basis in fact. These Because of her family history, Lisa, cancer or have a heart condition are aren’t numbers that I came up with, the girl’s mom, is at high risk of cer- dying rather than being cured. these are numbers that the Congres- vical cancer. Although she is supposed Pull out the medical records of these sional Budget Office came up with—$1.3 to get an exam every 3 months, she patients and the official forms will tell trillion. That is trillion with a ‘‘t.’’ It doesn’t go. She is lucky if she goes you they died from complications of cuts the deficit more sharply than any- once a year, and most of the time she disease or maybe some surgery. But thing Congress has done in a long time. is not very lucky. When Lisa lost her what is really killing more and more It lowers costs. I have talked about job, she lost her health coverage. Now Americans every day are complications Medicare. both Lisa and her daughter miss the due to our health care system. My friend, the Republican leader, tests and preventive medicine that Much of our attention this year has said it is going to reshape our Nation. could keep them healthy. Her long let- been consumed by this health care de- That is why we are doing it. That is ter ended with a simple plea. It was: bate. A national study done by Harvard why we are doing this. We want to re- ‘‘We want to be able to go to the doc- University found that 45,000 times this shape the health care delivery system tor.’’ year, nearly 900 times every week, in our country. Is it right that America That is why this bill will ensure all more than 120 times every day, on av- has 750,000 bankruptcies a year, about Americans can get the preventive tests erage every 10 minutes, on end, an 80 percent of them caused by health and screenings they need. I am voting American died as a result of not having care costs, and 62 percent of the people yes because I believe Lisa and her health insurance. Every 10 minutes. who have filed bankruptcy have health daughter deserve to be able to go to the The numbers are numbing, and they care costs? We are reshaping the Na- doctor. don’t even include those who did have tion. That is what we want to do. That A teenager named Caleb Wolz is a health insurance but who died because is what we have to do. high school student from Sparks, NV.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00006 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32912 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 Like so many students, he used to play with heartbreaking stories. They are Begich, Sheldon Whitehouse, Bill Nel- soccer when he was younger. Now he people who played by the rules and son, Roland W. Burris, Kirsten E. Gilli- sticks to skiing and rock climbing. You simply want their insurance company brand, Ron Wyden. can forgive him, I am sure, for giving to also do the same. They are not The PRESIDING OFFICER. By unan- up soccer. You see, Caleb was born with alone. These tragedies do not happen imous consent the mandatory quorum legs that end above his knees. only to Nevadans. They don’t happen call is waived. The question is, Is it the As children mature, even Caleb, they only to people who, despite all their sense of the Senate that debate on grow out of their clothes. Most kids pain, find time to write their leaders in amendment No. 3276 to the Reid sub- grow out of their shoes. Caleb doesn’t. Congress. These tragic events happen stitute amendment No. 2786 to H.R. A lot of kids probably get a new pair to people on the east coast, the west 3590, the Service Members Home Own- every year but Caleb has needed a new coast, and everywhere in between. ership Tax Act of 2009, shall be brought pair of prosthetic legs every year since These tragedies happen to Americans to a close? he was 5 years old. Unfortunately and in small towns and in big cities. These The yeas and nays are mandatory unbelievably, Caleb’s insurance com- tragedies happen to citizens on the left under the rule. pany has decided it knows better than side of the political spectrum and on The clerk will call the roll. his doctor and has decided Caleb the right side. As Mike Tracy wrote in The assistant legislative clerk pro- doesn’t need those legs. That is why his powerful letter about his son: ceeded to call the roll. this bill will make it illegal for those The yeas and nays resulted—yeas 60, Democrats need health care. Republicans nays 40, as follows: insurance companies to use preexisting need health care. Independents need health conditions as an excuse for taking our care. All Americans need health care. [Rollcall Vote No. 385 Leg.] money but not giving coverage. Get it done. YEAS—60 This is a big change. But isn’t it a He is right. Every single Senator, Akaka Franken Mikulski good change? I am voting yes because I every one of us, comes from a State Baucus Gillibrand Murray believe Caleb deserves a set of pros- Bayh Hagan Nelson (NE) where these injustices happen every Begich Harkin Nelson (FL) thetics that fit. single day. Every single Senator rep- Bennet Inouye Pryor Ken Hansen wrote to me from Mes- resents hundreds, thousands of people Bingaman Johnson Reed quite, NV, a town on the border of Ne- who have to choose between paying an Boxer Kaufman Reid vada, Utah, and Arizona. He has chron- Brown Kerry Rockefeller electricity bill or a medical bill; be- Burris Kirk Sanders ic heart problems and parts of his feet tween filling a doctor’s prescription Byrd Klobuchar Schumer have been amputated but Ken can’t go or—well, maybe just hoping for the Cantwell Kohl Shaheen Cardin Landrieu Specter to the doctor because he makes too best—between their mother’s chemo- much to qualify for Medicaid and too Carper Lautenberg Stabenow therapy treatment and their daughter’s Casey Leahy Tester little to afford private insurance. I college tuition. Conrad Levin Udall (CO) share with the Senate exactly what As I mentioned earlier, on average an Dodd Lieberman Udall (NM) Ken wrote me: Dorgan Lincoln Warner American dies from lack of health in- Durbin McCaskill Webb I am very frustrated because it seems my surance every 10 minutes. That means Feingold Menendez Whitehouse only hope is that I die very soon, because I Feinstein Merkley Wyden cannot afford to stay alive. in the short time I have been speaking our broken system has claimed at least NAYS—40 That is why this bill will expand two lives. Another American has died, Medicaid to cover people like Ken from Alexander DeMint McCain another American has died—two have Barrasso Ensign McConnell Mesquite, NV, who are caught in the died a preventable death, each of them. Bennett Enzi Murkowski middle. I am voting yes because when Bond Graham Risch So as our citizens face heart-rending someone tells me his only hope is to Brownback Grassley Roberts decisions every day, tonight every Sen- Bunning Gregg die, I think we have to take a close Sessions ator has a choice to make as well. That Burr Hatch Shelby look at that. I can’t look away. I can- Chambliss Hutchison Snowe choice: Are you going to do all you can Coburn Inhofe not possibly do nothing. Thune to avert the next preventable death? I Cochran Isakson A man by the name of Mike Tracy Vitter hope so. I urge an aye vote to stop this Collins Johanns lives in North Las Vegas. His 26-year- Voinovich filibuster. Corker Kyl old son has been an insulin-dependent Cornyn LeMieux Wicker Mr. President, I advise my Members diabetic since he was a baby. The in- Crapo Lugar that in 1984 the Senate adopted a reso- surance Mike’s son gets through work The PRESIDING OFFICER (Mrs. lution, S. 40, to impose a requirement will not cover his treatments and the SHAHEEN). On this vote, the yeas are 60, that Senators vote from their desks. I Tracys can’t afford to buy more insur- the nays are 40. Three-fifths of the Sen- know we do not do this all the time but ance on their own. But his family’s ators duly chosen and sworn having I ask tonight we do vote from our troubles are about more than just voted in the affirmative, the motion is desks and follow the rule, S. Res. 40, money. Since they couldn’t afford to agreed to. and have Senators vote from their treat his diabetes, it developed into The Chair announces that because desks. Addison’s disease—which of course cloture has been invoked, the motion they can’t afford to treat either. It CLOTURE MOTION to refer falls. could be fatal. The PRESIDING OFFICER. The mo- Mr. REID. I suggest the absence of a This is what he wrote to me 2 weeks tion to invoke cloture having been pre- quorum. ago: sented under rule XXII, the Chair di- The PRESIDING OFFICER. The I don’t know what to pray for first: that I rects the clerk to read the motion. clerk will call the roll. will die before my son will so I don’t have to The legislative clerk read as follows: The legislative clerk proceeded to bear the burden, or that I outlive him so I CLOTURE MOTION call the roll. can provide support to his family when he is We, the undersigned Senators, in accord- Mr. REID. Madam President, I ask gone. ance with the provisions of rule XXII of the unanimous consent that the order for Quite a set of prayers. This should Standing Rules of the Senate, hereby move the quorum call be rescinded. not be a choice any American should to bring to a close debate on the Reid amend- The PRESIDING OFFICER. Without have to make. It should not be a choice ment No. 3276 to the Reid substitute amend- objection, it is so ordered. any father or mother should have to ment No. 2786 to H.R. 3590, the Service Mem- Mr. REID. Mr. President, I would like bers Home Ownership Tax Act of 2009. to thank the employees in the Office of make—and when given the chance to Christopher J. Dodd, Richard Durbin, help people like Mike, our choice Max Baucus, Paul G. Kirk, Jr., Claire the Secretary of the Senate who read should be very easy. McCaskill, Jon Tester, Maria Cantwell, the managers’ amendment aloud for That is what this legislation is all Barbara A. Mikulski, Mark Udall, more than 7 hours on Saturday, De- about. These are hard-working citizens Arlen Specter, Sherrod Brown, Mark cember 19, 2009. They are:

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00007 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32913 Kathie Alvarez, John Merlino, Mary Anne draw his amendment so I would like to April 14, 1950, Senator Forrest C. Clarkson, Scott Sanborn, Leigh Hildebrand, set the record straight. Donnell insisted that an amendment Sheila Dwyer, Adam Gottlieb, Joe Johnston, First of all, before Senator SANDERS being offered by Senator William Ben- Elizabeth MacDonough, Ken Dean, Michelle withdrew his amendment, I consulted ton be read in its entirety. Afterwards, Haynes, Patrice Boyd, William Walsh, Valentin Mihalache, and Cassie Byrd. with the Senior Assistant Parliamen- Senator Benton sought unanimous con- sent to withdraw his amendment. Sen- The readers represent the offices of tarian, who was on the floor while I ator Donnell made a parliamentary in- the Legislative Clerk, Assistant Sec- was presiding. He assured me that a quiry of the Chair, asking the Pre- retary of the Senate, Parliamentarian, Senator has the right to withdraw an siding Officer whether a Senator may Bill Clerk, Journal Clerk, Executive amendment if no action has been taken withdraw an amendment while it is Clerk, Daily Digest, Enrolling Clerk, on it. No action can be taken on an being read. He further stated that if and the Official Reporters of Debates. amendment until it is officially pend- Mr. CARDIN. Mr. President, on ing. An amendment is not officially consent were necessary he would ob- Wednesday, the junior Senator from pending until it has been read into the ject. The Presiding Officer replied that Vermont offered his ‘‘single-payer’’ RECORD or such reading has been an amendment may indeed be with- health insurance amendment, amdt. waived by unanimous consent. drawn while it is being read, citing the No. 2837, to H.R. 3590. Under rule XV of It is important to understand that language in rule XV I just mentioned. the Standing Rules of the Senate, an while the Presiding Officer, not the And Senator Benton withdrew his amendment must be read aloud into Parliamentarian, makes rulings, it amendment. On September 24, 1992, Senator Brock the RECORD unless its reading is dis- would be unusual for him or her to ig- Adams offered an amendment to a tax pensed with by unanimous consent. nore the advice of the Parliamentarian. bill and sought consent twice to dis- Such consent is routinely granted but Martin Gold, who was the senior floor pense with reading it. In both in- in this instance, the junior Senator staffer to two former Republican ma- stances, Senator Bob Packwood ob- from Oklahoma objected so the clerks jority leaders, Howard H. Baker, Jr., jected so the clerk proceeded to read commenced with reading the 767-page and William H. Frist, MD, of Ten- nessee, writes in his definitive book, the amendment aloud. Later, Senator amendment. After several hours Adams asked for ‘‘permission’’ to with- passed, Senator SANDERS withdrew his ‘‘Senate Procedure and Practice,’’ that former Parliamentarian Floyd M. draw the amendment and the Chair re- amendment. plied affirmatively that he had the Later in the day, the Republican Riddick ‘‘claimed that in twenty-five right to do so. leader came to the floor and com- years of advising the presiding officer, the Senate only once voted to overturn The 1950 precedent is cited on page plained that ‘‘the majority somehow 119 of Riddick’s for the proposition him on appeal. He also cites an exam- convinced the Parliamentarian to that an amendment may be withdrawn ple of Vice President Alben Barkley ig- break with the longstanding precedent ‘‘even as soon as it has been read’’ but noring the parliamentarian’s advice, and practice of the Senate’’ with re- it is, in fact, the same ruling as the only to be overturned on appeal.’’ The gard to the reading of the amendment. 1992 precedent, that a Senator may Parliamentarian is a nonpartisan offi- He claimed that continued reading of withdraw his amendment while it is cer of the Senate. In the 72 years since the amendment could not be dispensed being read. with absent consent being granted, the position was created, there have The Republican leader did not refer suggesting that Senator SANDERS had been just five Parliamentarians. The to the 1950 precedent in his comments no right to interrupt the reading to Parliamentarian and his staff are expe- on Wednesday but spoke disparagingly withdraw his amendment. The Repub- rienced professionals. I sought and re- of what happened in 1992, saying, ‘‘the lican leader cited Riddick’s Senate ceived the Parliamentarian’s advice on Chair made a mistake and allowed this matter and I followed it, which is Procedure: Precedents and Practices, something similar (to Senator SAND- how the Senate usually operates. pages 43–44, which states, in part: ERS’ move) to happen. But one mistake Under Rule XV, paragraph 1, and Senate The Parliamentarian and his staff does not a precedent make.’’ precedents, an amendment shall be read by conducted extensive research on rule The Parliamentarian doesn’t share the Clerk before it is up for consideration or XV and the precedents governing the the Republican leader’s contention before the same shall be debated unless a re- reading and withdrawal of amendments that the 1992 action was a ‘‘mistake,’’ quest to waive the reading is granted; in prior to what happened during Wednes- practice that includes an ordinary amend- not a precedent. The Parliamentarian’s day’s session. While the Riddick’s text view is echoed by Walter Oleszek, the ment or an amendment in the nature of a the Republican leader cited seems substitute, the reading of which may not be noted senior specialist in American Na- dispensed with except by unanimous consent, plain enough, it is trumped by section tional Government at the Congres- and if the request is denied the amendment 2 of rule XV itself, which clearly and sional Research Service, CRS, who must be read and further interruptions are succinctly states: wrote last year, ‘‘Senators are free to not in order; interruptions of the reading of Any motion, amendment, or resolution modify or withdraw their amendments an amendment that has been proposed are may be withdrawn or modified by the mover until the Senate takes ‘‘action’’ on not in order, even for the purpose of pro- at any time before a decision, amendment, or posing a substitute amendment to a com- ordering of the yeas and nays, except a mo- them.’’ This is from Senate Amend- mittee amendment which is being read. tion to reconsider, which shall not be with- ment Process: General Conditions and When an amendment is offered the regular drawn without leave. Principles, CRS Report 98–707, May 19, order is it reading, and unanimous consent is 2008. Martin Gold’s book, ‘‘Senate Pro- Prior to the time Senator SANDERS required to call off the reading. cedure and Practice,’’ states: A Senator has, at the sufferance of the withdrew his amendment, no action When a senator sends an amendment to the Senate, reserved the right to object to dis- had been taken on it that would have desk, he continues to ‘‘own’’ that amend- pensing with further reading of an amend- prevented such a move without consent ment in the sense that he can modify or ment. for a very simple reason: the amend- withdraw it at will (my emphasis) . . . Once Later on Wednesday, the senior Sen- ment wasn’t officially pending while it ‘‘action’’ has been taken on the amendment, ator from Illinois ably addressed the was being read into the RECORD. So that situation changes, and the senator can Republican leader’s concerns but I Senator SANDERS had an unfettered modify or withdraw his amendment only by bring the matter up again because I right to withdraw it under such condi- unanimous consent. This is from page 102. was presiding at the time Senator tions. The minority has tried to argue that SANDERS withdrew his amendment and The precedent for a Senator’s ability there was Senate action on the Sanders Senator COBURN called for regular to withdraw an amendment while it is amendment because the Senate pre- order. I received several phone calls being read without gaining consent viously had agreed to a unanimous con- afterwards from individuals who first, either to dispense with the read- sent request defining the amendment claimed that I acted erroneously in ing or to withdraw it, was firmly estab- and the Hutchison motion to recommit permitting Senator SANDERS to with- lished in 1950 and reiterated in 1992. On as the only propositions in order at

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00008 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32914 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 that stage and prohibiting amendments RECESS UNTIL 12 P.M. TODAY groups, States, and to our Nation, but to them. It is true that if an amend- The PRESIDING OFFICER. The Sen- seldom do we address an issue of this ment is on a defined list of the only ate stands in recess until 12 p.m. today. magnitude or scope. This health care amendments made in order, that Thereupon, the Senate, at 1:33 a.m., reform issue literally touches every amendment when pending cannot be recessed until 12 p.m. and reassembled person who is following this debate and withdrawn except by unanimous con- when called to order by the Presiding many who are not even aware of it. sent. But that order is irrelevant in Officer (Mr. ROCKEFELLER). What we are doing is addressing some this case because, as I mentioned be- of the fundamentals of our health care f fore, the Sanders amendment was not system in America that need to be pending and could not be until it was SERVICE MEMBERS HOME changed. read in full or unless the reading was OWNERSHIP TAX ACT OF 2009 Whenever you are suggesting change dispensed with by unanimous consent. The PRESIDING OFFICER. Under in America, there is resistance. There Another way to put it is that the read- the previous order, the Senate will re- are people who are currently com- ing of the amendment was not ‘‘inter- sume consideration of H.R. 3590, which fortable with the health care system as rupted’’ by Senator SANDERS; in with- the clerk will now report. we have it, and there are people who drawing it he obviated the reason for a The bill clerk read as follows: are benefiting from the system as we reading. The order allowed but did not A bill (H.R. 3590) to amend the Internal know it, particularly health insurance require, as it could not, that Senator Revenue Code of 1986 to modify the first-time companies which enjoy great profits SANDERS offer the amendment and take homebuyers credit in the case of members of because of the current system of health steps to make it pending. the Armed Forces and certain other Federal care in America. But at the heart of So, to summarize, rule XV of the employees, and for other purposes. the issue, we know this system is Standing Rules of the Senate and the The PRESIDING OFFICER. Under unsustainable and, as a result, we have 1950 and 1992 precedents are clear that the previous order, the time until 12:30 engaged in almost a 1-year effort to Senator SANDERS was well within his shall be equally divided and controlled thoroughly investigate our health care rights to withdraw the amendment, the between the two leaders or their des- system and to find ways to change it reading of it notwithstanding. The Par- ignees. for the better. This has called on so liamentarian advised me accordingly The assistant Democratic leader is many of our colleagues to make ex- and I followed his advice. I would add recognized. traordinary contributions to this that Senator COBURN never explicitly Mr. DURBIN. Mr. President, this search for reform. objected to Senator SANDERS with- morning we are continuing to run time I wish to commend, first, our major- drawing the amendment. He called for postcloture on the managers’ amend- ity leader HARRY REID, who usually regular order. While regular order was ment. Following any leader remarks, stands at our caucus meetings and indeed the reading of the amendment, the time until 12:30 p.m. is equally di- says: Stop congratulating me; I am that status couldn’t prevent Senator vided between the two leaders or their just doing my job. I am going to do it SANDERS from exercising his right to designees. Senator REID has asked me anyway. Senator REID has worked tire- withdraw it. to serve as his designee on the Demo- lessly—and I have seen most of it first- Finally, I regret that several of my cratic side. At 12:30 p.m., we will begin hand—to build a coalition for health colleagues on the other side of the aisle alternating 1-hour blocks of time until care reform within the Democratic made comments that were critical of 6:30 p.m., with the majority controlling caucus. We didn’t have a single Repub- the Parliamentarian and his staff fol- the first hour. If all 30 hours lican vote that was in support of re- lowing this incident. The current Par- postcloture is required, then the roll- form in the early morning hours. I liamentarian helped to write, edit, and call vote on the managers’ amendment hope that changes as time passes, but revise Riddick’s Senate Procedure and will occur about 7:15 a.m. tomorrow, he had to build a coalition within our he has served in his current capacity as Tuesday morning, and the cloture vote caucus of conservative and progressive Chief Parliamentarian for 17 years and on the substitute will occur imme- Senators, and he did it, so we had all 60 counting, and as a Senate Parliamen- diately after that. So we expect at Democratic Members voting for health tarian for 33 years. He and his staff least two rollcall votes early Tuesday care reform. have a combined total of 84 years of ex- morning. Hopefully, votes will not be We are united in the belief that there perience. They are professionals who needed today to recess or adjourn this are fundamental things that need to be serve this institution and the Amer- evening. That is the state of play and changed in our health care system. ican people with distinction. business on the floor. First, it needs to be more affordable. I see the majority leader has arrived People cannot afford this dramatic es- f on the floor, and I wish to give him a calation in the cost of health care. Ten chance, if he is seeking that oppor- years ago, a health care policy for a ORDERS FOR MONDAY, DECEMBER tunity, to make any announcements he family of four offered through their 21, 2009 believes will be timely and appropriate. employer cost about $6,000 a year in Mr. KAUFMAN. Madam President, I The majority leader indicates he is premiums. That is $500 a month which, ask unanimous consent that the Sen- not going to make an announcement, instead of being paid to an employee as ate now stand in recess until 12 noon so I wish to make some comments salary, was taken from them for health today, that immediately upon recon- about where we are at this moment. insurance—$500 a month. vening at noon and after any leader I can’t imagine there are many peo- Today, that number has grown to time, the Senate then resume consider- ple in America who have been fol- $12,000 a year for an average family of ation of H.R. 3590, with the time until lowing this day’s session because it four for health insurance through their 12:30 p.m. equally divided and con- began at 12:01 a.m., when the Senate employment. One thousand dollars a trolled between the two leaders or was reconvened for a vote on the man- month that might otherwise go to a their designees; that from 12:30 p.m. to agers’ amendment to health care re- family for basic necessities of life and 6:30 p.m., there be 1-hour alternating form, which took place just a few min- savings and buying things that are im- blocks of time, with the majority con- utes after 1 a.m. this morning. We re- portant to their future instead goes to trolling the first block; that all cessed and now are returning for the pay for health insurance. That esca- postcloture time continue to run dur- rest of the legislative day. lation, that 100-percent increase in ing any recess, adjournment, or period When the history of the Senate is health insurance premiums in 10 years, of morning business until 6:30 p.m. written, I think this vote will be in- is troubling but not nearly as troubling Monday. cluded because it is a historic vote. We as the projection that if we continue to The PRESIDING OFFICER. Without consider many issues in the Senate of see an escalation in costs of health in- objection, the request is agreed to. great importance to individuals, surance premiums based on what we

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00009 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32915 have seen in the past, in another 8 nated by only two companies, and it is you need a colonoscopy. You may be years it will double again. Imagine 8 legal under our law for those two com- developing colon cancer. So the man years from now, in 2017, that you have panies to sit down and say: OK, how went and priced a colonoscopy proce- to work and earn $2,000 a month just to much are we going to charge? They dure and found out it was $3,000 he pay for your health insurance. How don’t compete with one another, they would have to pay out-of-pocket and he many people will be able to do that? conspire with one another to set pre- said: I don’t have it. So he didn’t go How many businesses will be able to af- mium rates. If you think I am a con- through with the procedure. That is a ford it? The answer is obvious. More spiracy theorist, what I am stating to risky thing, and it is something no one and more people will be dropped. you is what the law clearly says in the should have to face, but that is the cur- Today, 50 million Americans have no McCarran-Ferguson Act—something I rent system. health insurance. Many of them go to think should be repealed posthaste—be- What we are trying to do is change work every single day, but their em- cause they can sit down and set pre- that system so that basically pre- ployers can’t afford to provide health miums. They can also allocate mar- existing conditions are excluded from insurance or they are unemployed or kets. They can say to two companies: the discrimination of health insurance they have some other problem where You take over St. Louis and those two companies, that basic procedures that they have been excluded by a health in- companies will do Chicago and these are needed for prevention and wellness surance company. So in addition to two companies are going to do Wheel- are included in every health insurance dealing with the fundamental issue of ing, WV. They can set up the market policy. We are also making certain health care reform, we are focusing on structures so there is little or no com- that these health insurance companies affordability, how to bend the cost petition. How can that be good? If we can’t cut you off when you need them curve, as they say, or reduce the in- truly believe in a free market system, the most, can’t cancel your policy crease in costs of health insurance pre- how can this be good for America? when you face an accident or a diag- miums. I wouldn’t stand here and say So what we are doing as well is say- nosis where medical bills are going to to the people of America, with the pas- ing: We are going to change some of pile up. That is one of the provisions of sage of the bill we are now considering, these rules, some of the most egregious this bill as well. everyone’s health insurance is going abuses by these health insurance com- We also say, for families with young down, but I think I can say, with some panies—first and foremost, preexisting children who are off to college—and my confidence, the rate of increase is conditions. How many of us are in such wife and I have been through this—that going to decline, and that will give peo- perfect health that we can count on a you reach the point where you finally say: Wait a minute. My daughter is ple a better chance of affordability. health insurance company covering us graduating from college. I wonder if That is essential. without delving into our background, she is still under my family health in- Secondly, what about those 50 mil- finding something in our family his- surance plan. Today, in most cases, if lion uninsured people? I have met tory or something in our own personal your child has reached the age of 24, them, as the Senator from West Vir- history and saying: Well, we are either they are off your family plan. Well, we ginia has as well. These are not lazy, not going to cover you or we are going extend that now so those 24 and 25 will shiftless people who aren’t trying. to charge you dramatically more. have the protection of their family Many of them are trying hard, but they Those days have to end. health insurance plan while they finish don’t have a chance for health insur- Let me tell my colleagues what this school, look for their first job and ob- ance coverage for a variety of reasons. bill does. It says immediately—imme- tain their own health insurance. That We are going to change that. Of the 50 diately—children under the age of 18 is going to be peace of mind for a lot of million currently uninsured, over 30 with preexisting conditions cannot be families across America, just those 2 million will have insurance under this discriminated against by health insur- years when young people are the most bill. Those in the lower income cat- ance companies. You can’t deny them vulnerable and need the protection of egories will qualify for what we call coverage because a child is born and their family health insurance plan. Medicaid, which is a Federal-State develops diabetes. You can’t deny cov- Are these worth anything, these health insurance program for the poor erage because a child has had cancer changes? I think they are worth a lot. and disabled. Most of those people— and is fighting that cancer. You cannot I think that is why 60 Democrats stood those who make less than $15,000 a deny coverage because of those pre- proudly and voted for this. year—will not pay any premiums be- existing conditions. That is fundamen- Senator MCCONNELL, the Republican cause they can’t. They don’t have tally fair. It gets to the heart of what leader, turned to us in the midst of this enough money. For those who are mak- we should be doing as a nation. dramatic debate early this morning ing slightly more, we provide in this Senator TOM HARKIN of Iowa stood at and said: If one of you—and he pointed bill tax credits that will help people this podium early this morning and to all of us sitting here—doesn’t vote pay for their premiums. So if your fam- said: What this debate is about is against it, then all of you Democratic ily is making up to $80,000 a year, the whether health insurance is a right or Senators will own this. Tax Code will now help you pay for a privilege. If it is a privilege only for We know that, and we have pride in your monthly premium for health in- the wealthy in America, then we have that ownership because we know the surance. lost our way as a nation. We have to alternative. Those who voted against So we are going to expand coverage. understand that protection of our well- change are voting for a system that is Thirty million people are going to have being and health through health insur- unsustainable and morally indefen- the security of health insurance cov- ance is something every American is sible—a system which, frankly, today erage. We are bending the cost curve so entitled to. We have to understand we puts good, hard-working people, folks the increase in health insurance pre- are the only developed Nation on Earth who follow the rules, Americans who miums is not as steep, making sure where a person could literally die be- believe they are doing the very best for more people are covered, and then, cause they don’t have health insur- their country, at a distinct disadvan- equally important, we are changing the ance. tage for one of the most basic things rules when it comes to health insur- If you think that is overly dramatic, we expect in life: protection of good ance companies. let me give an illustration. health care when we are facing illness For too long, these health insurance A man I met in Illinois had a health and when we need a helping hand. companies have ruled the roost. Since insurance policy that wasn’t very good. This bill is also going to change the the early 1940s, they have been exempt It had a $5,000 copay. He had to take face of health care in America. I don’t from antitrust laws which allow them that copay so his premiums would be think I overstated it. Our bill has $10 to literally collude and conspire with low enough so he could afford it. That billion to be invested in community these set prices. Over half the insur- man went to a doctor who said to him: health clinics. Senator BERNIE SAND- ance markets in America are domi- I see some indications from tests that ERS of Vermont has been such a leader

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00010 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32916 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 on this issue and deserves credit for it. is the kind of misfortune I want to both sides of the aisle are anxious to He was dogged. Some Members looked avoid in the future. share their holiday season with their to this bill for a variety of things, but We also have one other item of busi- families. It is one of those special Senator SANDERS looked to this bill to ness remaining, and that is the debt times of the year. We now have a provide a helping hand across America ceiling of America. It is something record vote of 60 Members on this side through community health clinics. As none of us want to face. It is almost on health care reform. I hope we can those clinics are built and expanded, like making your monthly payment for get the agreement from the Republican more and more small towns in West the mortgage, and that is what it is, side to bring this matter to closure Virginia and in Illinois are going to the mortgage of America. We have to soon, to vote on the debt ceiling, and have satellite clinics where people, re- acknowledge the fact that as we fight a to have at least a short adjournment gardless of whether they are wealthy war and incur the costs, as we have the for some time for us to return home to or not as wealthy, will have a chance workings of government assessed, and our States and home to our families. to walk in the front door and see a we know there are costs, it adds to the Mr. President, if there is no one seek- medical professional. They will not be expense of our government, and some ing recognition at this time, I suggest queuing outside the emergency rooms of it is in debt, and that debt needs to the absence of a quorum and ask that of hospitals, where their care is much be extended for a short period of time the time under the quorum call be as- more expensive. They will be going to as we move forward into the next year sessed against both sides. these community health clinics and that begins in just a few days. This The PRESIDING OFFICER. Without meeting primary care physicians who debt ceiling issue is one we need to objection, it is so ordered. The clerk will give them the basic care they need come to grips with before we leave at will call the roll. The assistant bill clerk proceeded to before their medical problems become the end of this month. There is a short- term extension which I hope the Sen- call the roll. much more serious. Mr. BAUCUS. Mr. President, I ask That is what this bill is fundamen- ate will consider. unanimous consent that the order for tally about. There are many other I wish to also say that Senator CON- the quorum call be rescinded. RAD of North Dakota, chairman of the parts to it, parts I am proud to be co- The PRESIDING OFFICER. Without Senate Budget Committee, has been a sponsoring and proud to be sup- objection, it is so ordered. porting—giving a hand to small busi- real leader in talking about coming to Under the previous order, the time nesses, giving a hand to individuals to grips with this long-term debt. I have until 6:30 p.m. will be divided in 1-hour expand health insurance coverage. said to him, in the midst of a recession, alternating blocks of time, with the Some might ask: If you voted on it at with high unemployment, most econo- majority controlling the first block. 1 o’clock this morning, why are you mists believe it would be a mistake for Mr. BAUCUS. Mr. President, I wish still here? Because the minority is ex- us to pull back in terms of the safety to take a few moments this morning to ercising its right under the Senate net for families out of work, to pull talk about a provision in this package rules which requires us now to wait 30 back in terms of the investment in in- about which I am particularly proud. hours before we can vote again on this frastructure to put people to work, and This would finally follow through on one section of the bill. As I announced Senator CONRAD says he agrees. Al- the Federal Government’s responsi- this morning, that means that in the though he believes we need to be hon- bility to provide screening and medical early hours tomorrow morning, about est about the debt of America, he has care to residents at Superfund public 7:15 or 7:20, Senators will be coming to said to me repeatedly that he is not a health emergency sites. the floor again for two votes to move Hooverite, referring to that period in The term ‘‘public health emergency’’ this process forward. I understand it is history when the Great Depression hit is defined by the Comprehensive Envi- the right of the minority to ask us to and President Herbert Hoover believed ronmental Response Compensation and come in at 1 in the morning or early in government should address the debt of Liability Act of 1980, otherwise known the morning. They have that right. America instead of the depression of as CERCLA. People call that the Historically, we have usually reached America. He lost that election to Superfund law—CERCLA. That law re- some accommodation and agreement, Franklin Roosevelt in 1932 as a result serves the declaration of public health and I hope we can here. The 60 votes of that point of view. emergency for the most hazardous that were there last night will be there Many of us believe the debt is a seri- Superfund sites. These are sites where again tomorrow morning, and they will ous issue to be grappled with, but at the release or potential release of a be there every time needed until this the current moment we have to focus hazardous substance rises to the level bill is finally passed. on the millions of Americans out of of an emergency. Those on the other side believe this work who need a helping hand, first When a public health emergency is bill is so bad that it is going to revi- with unemployment benefits, COBRA declared, the law requires that the Sec- talize the Republican Party in the next benefits, food stamps, the basic neces- retary of Health and Human Services election. I disagree with them. I think sities of life. We have to provide oppor- provide screening and medical care the American people, as they come to tunities for education and training, services to people who have been ex- understand this bill, will view it in its and then we have to find a way to posed. But to date, the government has historic context, one of the most dra- spark this economy and move it for- not created a mechanism to allow the matic steps forward to provide peace of ward. Secretary to deliver the screening and mind and security to families and busi- Senator REID has given to me and medical care required under current nesses across America for an issue we Senator DORGAN of North Dakota the law. The bill before us finally provides know needs to be addressed. responsibility of looking at the Senate that mechanism. There are some who came to the floor jobs-creation package. We have been First, it authorizes a grant program yesterday—there was one Senator. I in- working on that, and we are close with for the screening services. These vited him to come in and explain his our colleagues in the House in coming screenings would determine if a med- remarks. He said people should say a up with some ideas on how to expand ical condition is present that is attrib- prayer that someone would miss the employment. I hope we can have bipar- utable to environmental exposure. vote at 1 a.m. I do not think we should tisan support for that. It would cer- Then, it allows those individuals with a be praying for misfortune for our Sen- tainly make it a lot easier, and it diagnosed medical condition due to the ators, that they would be delayed or would be done more quickly so that we environmental exposure at the site to for some other reason could not make do not lose jobs in the next construc- get medical care services. the vote. Instead, we should be praying tion season coming up next year. It also establishes a pilot program to to overcome the misfortune of 30 mil- That is the reality of the agenda we provide additional medical care appro- lion Americans who will not have face when we return. I did tell you that priate for the residents of the Super- health insurance if this bill fails. That now most Members of the Senate on fund site at Libby, MT. This language

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00011 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32917 responds to Libby’s rural nature and holding EPA’s feet to the fire because pany sure did not help matters. I might the lack of access to traditional care. they weren’t doing something such as a say, parenthetically, this is the same This provision is important because it base-level study. They didn’t know how company that is the subject of a book will provide vital medical services to clean clean was. They did not do a very and a movie called ‘‘Civil Action,’’ Americans who, through no fault of good job. where W.R. Grace contaminated the their own, have suffered horrible ef- A guy named Paul Peronard was the water in Woburn, MA. In my judgment, fects from their exposure to deadly poi- onsite coordinator, who was finally they knew what they were doing. It is sons. It will provide the vital medical able to convince EPA back in Denver clear they knew what they were doing. services we owe these Americans under what they had to do. In my personal As I recall, a big civil judgment was our commitment in prior legislation; judgment, they didn’t send Paul back rendered against W.R. Grace because it that is, the Superfund Act. because he was doing such a good job. was clear they knew what they were This provision is especially impor- Anyway, cleanup began in 2002, and we doing. They are now bankrupt. W.R. tant to me for a special reason. The still have a long way to go. Grace shoved all their assets to an- Environmental Protection Agency cur- For decades, the W.R. Grace oper- other location so the plaintiffs in the rently has 1,270 sites designated where ation belched 5,000 pounds of asbestos suit against W.R. Grace could not at- pollution contamination presents a into the air in and around Libby every tach their assets—and all the shenani- danger to public health and welfare. day. Deadly asbestos coated the town gans this company undertook for their Throughout the history of the pro- and its inhabitants. People used raw own benefit and at the expense of the gram, the EPA has found only one site vermiculite ore or expanded people in Libby. where conditions are so severe and the vermiculite to fill their gardens, their The type of asbestos in Libby is par- contamination so pervasive to have it driveways, they put the stuff on the ticularly deadly, and so many people in warranted a declaration of a ‘‘public high school track, the little league Libby are dead, dying, and sick because health emergency.’’ That declaration ballfield, and put the stuff up in their of this tremolite asbestos, an espe- occurred on June 17 of this year. EPA attics. It was used everywhere, this cially vicious, pernicious form of asbes- Administrator Jackson found that a stuff. People sort of sensed there was tos. This is not regular asbestos, such public health emergency exists at the something not quite right with all this as chrysotile, this was tremolite asbes- Superfund site in Libby, MT. vermiculite and asbestos, but it was tos mined at Libby, MT, where the fi- Many Senators have heard me speak kind of hard to put your finger on. bers are deeper and they are stronger. about Libby. Libby, MT, is a beautiful One day, I visited Libby, and I will They get in your lungs and they cause little town, a small town in north- never forget, when I went to the mine, more damage and it takes longer to de- eastern Montana, surrounded by mil- I was stunned to see these miners come tect. It is that vicious. off the mine and into their buses. They lions of acres of Federal forest lands. It The effect on Libby has been severe. were caked with dust. I mean, it added appears to be an idyllic spot. It is home Today, we know that nearly 300 resi- new meaning to a dustbin. They were to families of all ages. It is a place dents of Libby have died—300. It is a just caked with the stuff on their where people spend their lives creating small town. Thousands more have be- clothes. They got on the bus, went come sick with asbestos-related dis- a sense of community not often found home. ease. That is 291 deaths in a county of in the country today. It is also a town The one person I talked to and who 18,000. Lincoln County, MT, home to that has gone through lots of stress, got me interested in doing something Libby, has the highest age-adjusted lots of economic difficulties. The tim- about this—a guy named Les death rate due to asbestosis in the Na- ber industry has virtually shut down Scramsted—told me, when he got off tion. Libby, one of the mainstays in Libby. the bus, he would go home—caked with Libby is an isolated community with Mining there is not quite what it used dust—and embrace his wife, his kids limited access to health care. The me- to be in years past. Here the people would jump in his lap, and guess what: dian household income in Libby in 2007 work together. They love Libby. It is Les is now dead from asbestos-related was $30,000. When I say ‘‘isolated com- tucked away, almost isolated in the vermiculite. His wife is ill, and one of munity with limited access to medical northeastern part of Montana. Most his children has died as a consequence. care,’’ what do I mean? There is just people in Montana have never been to Think of the pain he went through. He not that much there. And the company Libby, and some don’t even know died because of mesothelioma asbestos. has reneged on its insurance policies. where Libby is, but they have this won- Also, even worse, he caused his wife to The company had mediocre insurance derful sense of community in their own be ill and caused his son to die because policies for folks, but as time goes on, town. of this disease. the company just backs off—backs off. However, Libby is also a Superfund Mine workers brought the dust home It is really what is happening in the site. It is the home of a big mine. It is with them, as I mentioned, on their health care reform here. They rescind— a place where hundreds of people have clothing. They contaminated their own renege on their policies for one reason grown sick and died—died due to perva- families without knowing the dust was after another. The poor folks, when sive presence of asbestos spewed from poison. We knew something was wrong, they know they have asbestos-related— the vermiculite mining and milling op- but we didn’t know it was that wrong. either cancer or other lung-related dis- erations of W.R. Grace. I think the company knew exactly ease, they do not have the resources to Gold miners discovered vermiculite what it was doing. In fact, I might say, go to get the medical attention. in Libby in 1881. In the 1920s, the the company has been subject to a I have been at this for years. It is so Zonolite Company formed and began criminal action against their officers, frustrating, it is so wrong what has mining vermiculite. In 1963, W.R. Grace with allegations the officers knew they happened to the people of Libby, MT. bought the Zonolite mining operations, were contaminating the people and It is this combination of devastating operated it, and made a lot of money, didn’t disclose it. That suit went on for characteristics that led the EPA Ad- frankly, and the mine closed in 1990. a year. It is true the officers were ac- ministrator in June to find that the The EPA first visited Libby in 1999. quitted not long ago, but in my per- public health emergency does exist at In October 2002, EPA declared it a sonal judgment, it was because of a the Libby Superfund site. This finding Superfund site. Cleanup was begun. It lousy prosecution. But it is an example was based on years of work, having was very pervasive, very difficult, and where somebody thought—a lot of peo- originally been recommended by the it was a hard time getting the trust be- ple thought—not only did the officers EPA in 2001. tween the EPA and the people in the of this company contaminate people, I might say, I read the transcripts be- community. A lot of people didn’t trust but they knew they were contami- tween EPA Administrators and OMB that EPA was doing the right job, not nating people at Libby, MT. back in those years. The EPA Adminis- doing it the right way. In fact, I had to Asbestos was everywhere in Libby for trator under the Republican adminis- get so involved in so many ways in decades. I must say, W.R. Grace Com- tration recommended that this action

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00012 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32918 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 be taken, but it was squelched at the there pleading for help, for some atten- can not get health insurance at all. White House by OMB. The correspond- tion: We are dying. Someone pay atten- And even worse, insurance companies ence is clear. This is exactly what hap- tion to us. We are a small, isolated don’t always live up to their end of the pened back then in a previous adminis- community up here in northwestern bargain. tration. That is why EPA has never Montana. Please, someone, pay atten- Sure, a lot of folks are happy with used this authority, and the Agency in- tion to us. the health care they have. dicates there are currently no sites on This did get our attention. I was Our doctors, nurses and hospitals and the National Priorities List that come stunned by the stories they told. I was medical research are the best in the close to the conditions at Libby. talking to Les over coffee and world. It is worth highlighting a few parts huckleberry pie—a very popular pie up But when you add it all up, many are of the Administrator’s findings. Let me in Libby. Les was watching me very paying too much for it. Or nothing for indicate what they are. The Adminis- closely when I said: You bet, I will help it. Too many lives are lost. Too much trator has said: do something about this. He was very money is wasted. And too many folks The Libby Asbestos Site is unique with re- wary. are falling through the cracks. spect to the multiplicity of exposure routes After his neighbors and friends had They are calling out for help. I have [all ways this stuff gets to them], the cumu- finished telling me their stories, I will heard their voices. Now I want you to lative exposures experienced by community never forget that Les came up to me hear their stories. They are ordinary members, and the adverse health effects and said: Senator, a lot of people have people who stand to lose everything from asbestos exposure already present and unless we reform our health care sys- documented in the residents. come to Libby, and they told us they would help. Then they leave and noth- tem. Investigations performed by the Agency I support this health care reform bill for Toxic Substances and Disease Registry ing happens. (ATSDR) have found hundreds of cases of as- He told me, I remember, I think at because it saves lives. It saves money. bestos-related disease in this relatively that instant—you know, in life some- It saves Medicare. And it is tough on small community. ATSDR documented a dis- times you find four, five, six, seven in- insurance companies—taking them to ease and death rate from asbestosis in the stances, man to man, whatever it task to ensure affordable, fair cov- Libby area significantly higher than the na- takes, you are going to make sure they erage. tional average for the period from 1979–1998. I have a perspective different than The occurrences of disease are not limited to get justice; whatever it takes, what- ever it takes. Such a commitment. most of my friends in the Senate. vermiculite facility workers or their fami- I am—and always will be—a third That was one. I said to myself: Boy, I lies, but are spread throughout the popu- generation Montana farmer. My wife am going to do whatever it takes to lation. Sharla and I do all the work on our take care of this because these people This is pervasive in the town—ball- farm. I am the guy sitting on the trac- of Libby deserve justice. They have not fields, tracks, lawns; it is awful. tor. Medical care in Libby has historically been received it. A farmer knows a good year from a limited due to Libby’s isolated location and He said: Senator, I heard you say bad year. And I have had my share of economic situation, thus reducing the that, but I will be watching you. bad years. In fact, for a few of those chance of early detection and treatment of I knew he would watch. I knew that years—not long after our first kid was asbestos-related disease. would help. I didn’t actually say it be- born—Sharla and I had to give up cause I was going to do it anyway. I ac- This piece bears repeating: health insurance to make ends meet. Let me refine that point. For a long cepted Les’s offer, and I have a big pho- We had no other choice but to hope and time, we have been talking to lung spe- tograph of Les behind my desk. pray for health and safety. cialists across the country about the Les passed away a couple or 3 years Thank God our prayers were an- Libby tremolite asbestos, and we got ago. I spent a lot of time with him and swered. just so-so responses about how dan- his family at the hospital. I have a Now, I have the honor of serving gerous it was. Why? Because virtually wonderful picture of Les Skramsted Montana in the Senate. none of those doctors had experience that reminds me what we have to do But mine is one of the thousands of dealing with the pernicious kind of as- for the people of Libby but also for all real Montana families that has been bestos we have in Libby, MT. It took a the people in the Nation, people like forced to wing it, rather than depend long time to get their attention. We fi- Les Skramsted. It means that much to on a health care system that works. nally got some doctors to say this stuff me. And that holds insurance companies in Libby is wicked stuff. That is why, I have not forgotten Les. I will not accountable. frankly, EPA has started to understand forget Les. That is why this provision I know of a woman from Ravalli, MT, how bad this really is. is in here. I think Les, right now, up who cannot afford health insurance be- Essentially, the lack of access to there, may be smiling, saying: Yup, he cause of her pre-existing condition. She health care services in Libby—I will did not forget Libby, he did not forget and her husband got letters from the say it again—has actually worsened Les. That is what this provision is all insurance company telling them their the effects of this contamination. It about. premiums were going up, $500, to $600, just worked to their disadvantage. This is a photograph behind me of to $700 per month. Through no fault of The language before us today helps Les Skramsted in Libby, MT. He is in her own, her insurance just became too to solve this. It allows us to fulfill the a cemetery there, graves of lots of peo- expensive. So she gave up. commitment we made to the people of ple in Libby who died. Les played a This legislation will prevent that Libby when we passed the Superfund pretty mean guitar. He was a great sort of nonsense in the insurance in- Act 30 years ago. Heaven forbid, if in guy—still is, always will be. dustry from happening again. In this the future another Superfund site like I yield to my colleague from Mon- bill, a health insurer’s participation in Libby emerges, the bill before us today tana, Senator TESTER. the exchanges will depend on its per- will allow the Secretary to use the au- The PRESIDING OFFICER. The Sen- formance. thorities in this provision to fulfill our ator from Montana is recognized. Insurers that jack up their premiums commitment to provide health care Mr. TESTER. Mr. President, come before the exchanges begin will not be services for those residents as well. snow or sunshine—day or night—we are included. That is a powerful incentive I can never talk about Libby without close to sealing the deal to change our to keep premiums affordable. remembering my friend Les country for the better, to finally hold We all have friends and relatives who Skramsted. I mentioned his name a few insurance companies accountable, and aren’t fortunate enough to have a job moments ago. I first met Les in the to make health care affordable for all where health insurance is part of the year 2000 at the home of Gayla folks in this country. deal. So they do what millions of oth- Benefield. Les was there, Gayla was Right now we are all paying far too ers are forced to do: they hope and pray there, and lots of other miners were much for health insurance. Many of us they stay healthy.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00013 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32919 We have a problem. It is time for a check out. So she asked about her op- their homes or their family ranches to solution using common sense and fiscal tions. She was told if she wanted to pay the medical bills. responsibility. And that is why I am start chemo, she would have to come I know a lot of folks already have going to vote for this health care re- up with more than $100,000 in cash. Her health insurance, and they are won- form bill, so we can save lives, save only option was to sell her home. dering, how is this going to affect me. money, save Medicare. And so we can Mindy and her children sold their Let me be clear: If you like your plan, hold insurance companies accountable, home, and moved into an apartment. you get to keep it. If you don’t, you so they don’t drop people when they They packed up and moved out of their can look for a more affordable plan are sick, or drive families into bank- home so they could sell it and she that works best for you and your fam- ruptcy. could start the treatment she needed ily. Everyone will have access to af- Because of tax credits, this bill is to stay alive. After many years of try- fordable health insurance. Right now good for small businesses. It gives eli- ing to repay that debt, Mindy recently those with health insurance are sub- gible small businesses access to up to 6 declared bankruptcy. sidizing those without. years of tax credits. That will help I have heard many stories from folks The other day I struck up a conversa- small businesses buy health insurance in Montana who are in the same boat tion with a trucker back in Montana for their employees. that Mindy is in. This isn’t good busi- who told me: I don’t need insurance. I Because of tough new rules for the ness. This needs to stop. It is why I don’t want insurance. I don’t get sick. insurance industry, it is good for fami- support this health care reform bill. I I asked: What happens if you get into lies and kids. support it because under this bill, an accident? You are a trucker; that is And because of commonsense ideas Mindy and people like her wouldn’t always a possibility. He said: All I have like cross-State insurance markets, have to declare bankruptcy. She would to do is go to the emergency room more competition, and more choices, it have had insurance, despite her pre- where they take care of me, no ques- is good for millions of Americans who— existing condition of being a cancer tions asked. until now—have had to rely on hope survivor, and her annual out-of-pocket That is exactly the problem. When and prayers. expenses would have been capped at no everybody is insured, costs will go If we do not pass this bill, our entire more than $5,950 per year, not the down, because no one will be paying economy could fall apart beyond re- $100,000 in cash she needed to start can- extra to cover the folks who rely on pair. Right now we are working hard to cer treatment. This bill is strong and the emergency room for health care rebuild our economy, and it is working. decisive and tough on insurance com- that they eventually never pay for. It We are creating jobs and investing in panies so they cannot say, sorry, but is common sense. It saves lives, and it the basic infrastructure needed to get no, when you get sick; so they cannot saves money. our economy back out of the ditch. say, sorry, but no, if you have a pre- I have been on the phone with tens of Fixing our broken health care system existing condition. thousands of Montanans over the past is part of that job. Another story is about former ranch- few weeks answering questions about Over the past few years, I have heard ers Dan and Pat Dejong. This picture is health care. A lot of them want to from thousands of Montanans telling of Pat. Dan and Pat used to own a cat- know how we are going to pay for this me about the need to fix health care. tle ranch in northwestern Montana. bill. How much will it increase our One of them is Roxy Burley. Roxy The ranch had been in their family for debt? owns a hair salon in Billings, MT. It won’t increase our debt one thin She just bought a home. She works four generations. Dan and Pat couldn’t afford health insurance. Then Dan was dime. In fact, it will lower our deficit hard. But she just can’t afford health by hundreds of billions of dollars, $132 insurance. So, she says, she is walking diagnosed with cancer. To pay the bills they had to make the painful decision billion over the next 10 years alone. It a tightrope. Her home and her business reduces the deficit even more in the are on one side. Her health is on the to sell off their ranch. I am going to tell you, when a piece decade after that. The fact that this other side. bill saves money is pretty important to If Roxy gets sick, she worries she will of land has been in the family for four me. It doesn’t add to the deficit. It cuts lose her home and her business. generations, you develop an attach- In Montana, our economy relies on ment to that piece of land. But none- billions of dollars of government waste. people like Roxy Burley. We can’t af- theless when Dan got cancer, they had It requires a bigger chunk of your pre- ford to have our economy walking a to pay the bills. They sold the family miums to go directly to better health tightrope. ranch. Under this bill, the Dejongs care instead of administrative costs In this bill, Roxy will be protected would have had access to subsidies so and profits, it saves money for families from losing her home and business. Her that they could have afforded health by lowering costs for everyone and by annual out of pocket expenses are insurance in the first place. They never limiting the amount of money you capped at no more than $5,950 per year. would have had to sell the ranch to pay have to pay out-of-pocket for health I want to share another story that the doctors’ bills. care and by emphasizing wellness and hits home for me. It is the story of I want to read what Pat wrote to me prevention—the low-hanging fruit of Mindy Renfro. She lives in Missoula, about that experience: health care reform, and by holding in- MT. The cancer ravaged Dan’s body, but selling surance companies accountable so we Mindy got breast cancer not just our ranch to pay for medical costs broke his don’t pay more than our fair share for once, not just twice, not just three spirit. the health care we need. times—four times: Breast cancers, four Dan Dejong lost his battle with can- When you turn on the TV these days different cancers. cer 2 years ago. All his bills were paid, or open the newspaper, you see all The same cancer didn’t come back. but the ranch that had been in the fam- sorts of spin about the health care re- She got a different cancer each time. ily for four generations was gone, as form and Medicare. It amazes me how The first two times, Mindy’s insurance well as Dan. After all that, Pat still distorted the facts have become. I have paid for her treatment. cannot afford health insurance today. read the bill. The plain-as-dirt fact is it The third time, the insurance com- Under this health care reform bill, makes Medicare stronger. All guaran- pany called her and said: We are sorry, getting sick won’t force folks such as teed Medicare benefits stay as they but we are not going to pay. The under- Dan and Pat Dejong to sell the land are. They are just that—guaranteed. writer, she says, determined her that has been in their family for gen- Seniors are guaranteed to keep their chances of survival were just too slim, erations. That is because it limits the benefits, such as hospital stays, access so instead they offered to send a hos- amount of money you would have to to doctors, home health care, nursing pice nurse. pay out-of-pocket to a rate you can af- homes, and prescription drugs. How do Mindy was a single mom in her early ford based on how much you earn. That we make Medicare stronger? We make 40s, and she was simply not ready to means no Americans would have to sell it stronger by getting rid of wasteful

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00014 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32920 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 spending, by making prescription drugs The PRESIDING OFFICER. The Sen- Senate bill, in the House bill there is for seniors more affordable, and by ator from Vermont. $14 billion. My strong hope, expecta- spending your money smarter. Mr. SANDERS. Mr. President, I was tion, and belief—and I have talked to Without this bill, Medicare will be on proud last night to have voted for the the White House about this and the the rocks within a matter of years. If health care bill. The reason is, as Sen- Senate leadership and House leader- we don’t fix it now, it will go broke, ator TESTER indicated, this bill accom- ship—is that when this bill is finally leaving entire generations in the lurch. plishes a whole lot. Before I go on to passed, we will adopt the House lan- Millions of Americans have worked talk about what I want to focus on this guage which calls for $14 billion. hard all their lives for Medicare bene- afternoon, I do want to say there are a Let me tell you why this money is so fits. They have earned it. That is why number of provisions in the Senate bill terribly important. In a few days, the we are making Medicare better, not I don’t support and I hope we can im- Senate will be voting on final passage worse. That is common sense. prove in the conference committee by of a historic health reform bill that The same goes for VA health care. adopting the House language. One is will insure an additional 31 million This bill does not affect VA health care the issue of the public option, with Americans who have no health insur- or TRICARE. I serve on the Veterans’ which the Presiding Officer has been so ance. That is a huge accomplishment. Affairs committee. Over the past 3 strongly involved. At the end of the About half of the new people who will years we have made good progress in day, it seems to me the American peo- get health insurance will be enrolled in delivering the promises made to vet- ple have been very clear. If they are an expanded Medicaid Program. While erans. We still have a lot of work to do, not happy with their private insurance, this reduction in the number of unin- but this health care reform legislation they want the option of a Medicare sured is an essential step in achieving takes us forward even further for type public option. I think we should reform, we have to ask a very simple America’s veterans. give them that. question: If 15 million more people go Finally, this bill preserves some of Furthermore, as we look at the soar- into Medicaid, where are they going to the most important parts of quality ing cost of health care, we understand access the health care they need? health care: the relationship between that one important mechanism to con- It is no secret that today Medicare is you and your doctor and the freedom of trol escalating health care costs is a a strained program. When some of my choice you have as a patient. In Mon- public option which provides real com- Republican friends make that point, I tana, as in many parts of the country, petition to private insurance compa- have to say they are right; it is a we don’t tolerate the government nies that are only concerned about strained program. That is why expand- snooping around our private lives or making as much money as possible. I ing community health centers in the making personal decisions for us. know the Presiding Officer has worked National Health Service Corps is so im- Health care is no exception. This very hard in that effort. I hope we can, portant. health care reform bill not only saves in that regard, take the House lan- We talk about the number of people lives, it saves money and saves Medi- guage which includes a public option. uninsured—a very important number— The other area where I disagree with 46 million. But we do not talk about care. It keeps the government out of the Senate and agree with the House is the number of people who every day do the exam room and waiting room. on the issue of taxing health benefits I go home to Montana about every not have access to a physician or a den- for middle-income workers. The House weekend to visit with the folks and tist on a regular basis, and that num- provision raises substantial funding by ber is close to 60 million. These are hear what is on their minds. I meet putting a surtax on the very wealthiest people who, when they get sick, cannot with doctors and nurses, hospital ad- people in the country, people who re- find a doctor. Where do they go? ministrators and regular folks from all ceived huge tax breaks during the Bush Well, several things happen. They over the State to hear their concerns. years. That makes a lot more sense to may end up going to the emergency Everywhere I go, health care is the No. me than taxing the health benefits of room, which is the most expensive 1 issue. It is clear that the worst option middle-income workers. form of primary health care we have— is to do nothing at all. If that happens, Having said that, I want to focus on that is where they go—or even worse, insurance companies won’t be held ac- one new provision that was placed in they do not go to any doctor at all. countable. As costs go up, health care the health care reform bill by Majority What happens is, they get sicker and costs will continue to break families Leader REID. I thank him very much sicker. Then they go stumbling into a and people who need treatment to stay for his strong support for this concept. doctor’s office, and the doctor says: alive won’t get it. I also thank DICK DURBIN, CHUCK SCHU- Why didn’t you come in here 6 months I know a fellow farmer who worked MER, PATTY MURRAY, the Presiding Of- ago? some land back in Montana. When he ficer, and the entire Democratic lead- And the person says: I don’t have any got sick, he had to sell off entire ership for their support. health insurance. I couldn’t afford it. chunks of his family farm to pay the That provision simply provides $10 Then they go to the hospital, and we bills, piece by piece. Piece by piece, I billion over a 5-year period to the Fed- spend tens and tens of thousands of watched as he made painful sacrifices erally Qualified Health Center Pro- dollars treating somebody who is now for his health care. Piece by piece, his gram and the National Health Service suffering in a way they should not be livelihood was broken apart. No Amer- Corps. In my view, these two programs suffering, at greater expense to the sys- ican deserves that. are some of the best and most effective tem than should have been the case. People are calling out for help, be- public health care programs in the Now, what sense does that make? cause a lot of folks are falling through United States. They enjoy widespread Let me tell you the worst-case sce- the cracks. I say to them: We are lis- bipartisan support. President Bush was nario. The worst-case scenario is, they tening. We hear you, and we are doing a supporter. JOHN MCCAIN, when he ran walk into the doctor’s office, and the something about it. That is why this is for President, was a supporter of com- doctor says: It is too late. I can’t help a good bill. It is a bill I support. It will munity health centers. Many Repub- you anymore. You should have been in allow Americans to get the health in- licans have spoken positively of com- here 6 months ago. I have talked to surance they have needed, and the in- munity health centers, as have vir- physicians who have told me about surance will be affordable. It is the re- tually all Democrats. The reality, how- that. I suspect the Presiding Officer sult of a lot of hard work and working ever, is that both community health has as well. That is why this year we together to do what is right for the centers and the National Health Serv- are going to see 45,000 of our fellow country—for America’s rural families, ice Corps have been starved for funding Americans die because they do not seniors, veterans, small businesses, for many years. We are finally, in this have health insurance, and they do not family farms, and ranchers. The people bill, doing right by them. get to the doctor when they should. of this country deserve no less. I should mention, importantly, that Now, one of the advantages of the I yield the floor. while we have placed $10 billion in the community health care program is

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00015 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32921 that it is an enormously cost-effective cally tailored solutions that improve drugs, primary health care—in 5 years program. One study recently reported access to care and the health of those going from 20 million to 45 million peo- that $20 billion is wasted every year in they serve. ple. this country in unnecessary and inap- West Virginia centers will be dif- This funding would create new or ex- propriate use of hospital emergency ferent than Vermont centers, which panded health centers in an additional rooms for nonemergency care. When will be different than California cen- 10,000 communities—10,000 commu- you walk into an emergency room—I ters because they are designed and lo- nities—from one end of our country to do not know about West Virginia—but cally controlled to serve the needs of the other. In some cases, entirely new in Vermont it is about $600. If you get the local population. federally qualified health centers that similar care for a nonemergency- By mission and mandate, community would be established. In other cases, type ailment, the cost is $100. So think health centers must see all those who new satellite centers would be created. about all of the money we save—we seek their care regardless of health sta- In Vermont, for example, we have eight save—when we have community health tus, income level, or insurance status. community health centers. We have 40 centers expanding all over the country. If you are rich, if you are poor, you will total sites. That is true all over this One of the issues we have not focused gain access to these community cen- country. on enough, in my view, in this whole ters. Nobody is tossed away. Today, But can you imagine, Mr. President, health care debate is the very serious these health centers are America’s that in the United States of America, crisis in primary health care in gen- health care home to one out of every within a 5-year period, 10,000 new com- eral. The American College of Physi- four low-income uninsured individuals, munity health centers in this country cians, in a recent report, warned that one out of every six rural Americans, would be established? People would not the Nation’s primary care workforce— as well as one out of every seven Med- have to go 50 or 100 miles to find access which it called ‘‘the backbone of our icaid beneficiaries, and one in four low- to health care. It would be there in health care system’’—is, in its own income people of color. We need to their own community. It would be in words, ‘‘on the verge of collapse.’’ That guarantee that as we expand coverage, urban areas, in rural areas. This is ex- is the American College of Physicians. we expand community health centers traordinary. Over the past 8 years, for example, as well. They are the one primary care Now, these community health cen- the number of family practice resi- provider who will see those on Med- ters and the growth of these commu- dents fell 22 percent, while the overall icaid without restrictions. nity health centers do not mean much number of medical residents rose 10 Furthermore, community health cen- unless we have the medical personnel percent. Currently—this is an extraor- ters already employ so many of the fea- to adequately staff them. dinarily frightening statistic—only 2 tures of what we seek in the medical As I mentioned a moment ago, every- percent of medical students interested home model. They provide integrated body concludes we have a real crisis in in internal medicine intend to pursue health care, which is what we are talk- terms of access to primary health care primary care as their specialty—2 per- ing about. in this country and the number of phy- cent. A study recently by George Wash- sicians and dentists and nurses who This growing crisis was recently un- ington University—we are talking serve in the primary care area. What derscored in a report by the Associa- about spending money. What is so ex- this language does, that we have just tion of Academic Health Centers, citing about this whole concept is you added, is it would—if we adopt the which warned that the country is rap- are going to create more health care House numbers—triple funding in a 5- idly running ‘‘out of time to address opportunities for people, and you save year period for the National Health what is out of order in our health money—save money—by keeping them Service Corps, which provides loan re- workforce.’’ out of the emergency room and out of payments and scholarships to medical The good news is that 20 million of the hospital. A study by George Wash- students. those people who live in medically un- ington University found that patients For the University of Vermont Med- derserved areas are fortunate to live using health centers have annual over- ical School, if my memory is correct— where there are federally qualified all medical care costs that are more this is fairly typical for America—the community health centers. than $1,000 lower than those who do not average medical school student grad- Let me explain a bit. What is a feder- use a health center—$1,000. That trans- uates with $150,000 of debt. Well, if you ally qualified health center—which ex- lated to more than $24 billion in sav- graduate with $150,000 of debt, what are ists in all of our 50 States? It is a cen- ings for the health care system last you going to do? You are not going to ter which says: If you have no health year alone. do primary health care. You are going insurance, you can walk in and do you We are keeping people out of the to go into some fancy specialty and know what. You will pay not only for emergency room, we are keeping peo- start making a whole lot of money to primary health care but for dental ple out of hospitals, and we are keeping pay off that debt. But what the Na- care—which is a huge problem all over them from getting sicker than they tional Health Service Corps will be this country—for mental health coun- otherwise would be. That is why I am able to do is provide debt forgiveness seling, and you will get the lowest cost so pleased Majority Leader REID has and scholarships for an additional prescription drugs available in Amer- looked at this track record and con- 20,000—an additional 20,000—primary ica. And if you do not have any health curred that we will guarantee—guar- care doctors, dentists, and nurses. That insurance, you get it on a sliding-scale antee—funding of health centers over is a lot of new medical personnel that basis. If you have Medicaid, you are the next 5 years in order to provide is going to get out into underserved welcome into the center. If you have health care to more people and to save areas all over America. That is a very Medicare, you are welcome. If you have money at the same time. exciting thought. private health insurance, you are wel- Let me tell you in concrete terms In short, when we more than double, come into these centers. Currently, what $14 billion—the amount of money in 5 years, the number of people who these centers serve 20 million Ameri- that is in the House bill—will mean to have access to community health cen- cans in all of our 50 States. the American people. What it will do is ters, and within that same period of Conceived in 1965 as a bold, new ex- it will increase the number of people time we add an additional 20,000 pri- periment in the delivery of preventive who have access to community health mary health care doctors, dentists, and and primary health care services to our centers, from the current 20 million to nurses, we are talking about nothing Nation’s most vulnerable people and 45 million over a 5-year period—20 mil- less than a revolution in primary communities, community health cen- lion to 45 million. We are more than health care in America—something ters are an enduring model of primary doubling the number of people who will which we have needed for a long time. care for the country and are designed be able to walk into a clinic for health So let me conclude by saying: I want to empower communities to create lo- care, dental care, low-cost prescription to again thank the majority leader,

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Senator REID. I want to thank Senator vices? I think that is something we But then the doctors told them about DURBIN, Senator SCHUMER, Senator ought to consider if we are considering a new pediatric medical device called MURRAY, and thank the Presiding Offi- the quality of life in America and qual- the Berlin heart. The Berlin heart is an cer and the Democratic leadership for ity health care to preserve that life and external device that performs the func- their support of this concept. As you extend life expectancy. tion of the heart and lungs. It is de- know, this idea was developed back in During the markup of the Finance signed for a long-term support to keep the 1960s with Senator Ted Kennedy, Committee bill, I asked the question to infants and young children alive for up who developed this concept in the first the nonpartisan Congressional Budget to 421 days while they wait for the place. It has expanded, and now we are Office and the nonpartisan Joint Com- donor heart—obviously a lot longer going to take it a giant step forward mittee on Taxation—and let me em- than the 3 weeks on ECMO. So the Till- and, in the process, I think we are phasize the word ‘‘nonpartisan’’ be- mans decided to move forward with the going to make a difference—a real dif- cause these folks are professionals. So Berlin heart. ference—in improving the lives and the both of these organizations, the Con- After 13 days of being on ECMO with- well-being and the access to health gressional Budget Office and the Joint out any movement, Tiana underwent care of tens of millions of Americans. Committee on Taxation, said these ex- surgery to connect the Berlin heart. So Mr. President, thank you very much. cise taxes will be passed on to con- we have pictures here that show what With that, I yield the floor and suggest sumers in the form of higher prices and this is like. These two photos are of the absence of a quorum. higher insurance premiums. Tiana with the Berlin heart. You can The PRESIDING OFFICER. The Also, I wish to emphasize on this see that this device is run by a laptop clerk will call the roll. chart a statement of the Chief Actuary at the foot of the hospital bed. It The bill clerk proceeded to call the of the HHS. The Congressional Budget pumps the blood through her body, a roll. Office, the Joint Committee on Tax- job that her heart could not perform on Mr. GRASSLEY. Mr. President, I ask ation, and the Chief Actuary all say its own. unanimous consent that the order for the tax gets passed on to consumers. Unlike ECMO, the Berlin heart and the quorum call be rescinded. Who are the consumers of these de- its long-term support capabilities al- The PRESIDING OFFICER. Without vices? Who is going to bear the cost of lowed the Tillmans some peace of mind objection, it is so ordered. the new medical device excise tax? while they waited for that donor. The Mr. GRASSLEY. Mr. President, I Well, it is quite a burden, so I am going doctor said that the Berlin heart would call to the attention of the lead- to share some real-life stories here. helped Tiana regain her strength be- ership of the majority party that I I will start by telling the story of the cause she was off the paralytic medica- have a unanimous consent request I Tillman family, a family who would tion and was finally able to move. Not wish to make. I am going to be visiting bear the burden of this new medical de- long after Tiana was connected to the with my colleagues about the issue of vice tax. At only 5 months old, Tiana Berlin heart, a donor was found and taxes on medical devices, so my unani- Tillman had her life saved by a medical Tiana underwent an 8-hour transplant mous consent is in regard to that. I device. This story has received a lot of surgery. The risky surgery was a suc- hope people would observe that if there attention because Tiana’s father is a cess. Usually it takes some time for is an effort to block this motion I am professional football player for the Chi- the new heart to start working, but going to make, I think it is an endorse- cago Bears. However, lifesaving stories doctors said that due to Tiana’s ment of the tax on medical devices such as this happen all across the coun- strength, her new heart started work- such as the Berlin heart and hundreds try regularly. ing immediately. of others that children across this When Charles Tillman reported to I wish to talk about the tax on de- country rely on. training camp in 2008, it wasn’t long vices such as this. With that in mind, I ask unanimous before his coach told him that his 5- This picture shows Tiana today hold- consent to set aside the pending month-old daughter Tiana had been ing a football. That is Tiana today, and amendment in order to offer my mo- rushed to the hospital. When Charles we shouldn’t be surprised about her tion to commit. got to the hospital, Tiana’s heart rate love for football, considering her father The PRESIDING OFFICER. Is there was over 200 beats per minute. That is a professional football player. She objection? doctor told Charles and his wife Jackie enjoys playing on her swing set and Mr. DURBIN. With regret, I object. that Tiana may not make it through watching her dad play football. The PRESIDING OFFICER. Objec- the night. Tiana survived that night, There are many people responsible tion is heard. and after a series of tests, she was diag- for the successful effort to save Tiana’s Mr. GRASSLEY. Mr. President, it is nosed with cardio myopathy, an en- life, but without the Berlin heart to disappointing for those of us on this larged heart that is unable to function keep her alive and help her to gain side of the aisle to not be permitted to properly. Her condition was critical, strength, they may not have had that offer an amendment or motion that is and without a heart transplant she opportunity. as important as this, so I will go ahead would not survive. But finding pedi- What does this legislation have to do with my remarks. atric donors is very difficult and many with this story about Tiana? Well, the This is another major problem in the children do not survive the long wait Reid bill would increase costs for fami- Reid bill. Of the many taxes in this time, so Tiana was immediately put on lies such as the Tillmans. In fact, the bill, I am especially worried about the an ECMO, a device that would help the Reid bill would tax every pediatric excise tax on medical devices. Medical function of the heart while Tiana wait- medical device. device technology is responsible for ed for a transplant. Pediatric devices aren’t the only de- saving many lives and extending the However, ECMO is an old device that vices affected by the tax on medical de- overall life expectancy of people in the has many shortcomings. Infants can vices in the Reid bill. The Reid bill also United States. only survive on ECMO for about 3 taxes one of the most important mod- In the United States, over 6,000 com- weeks, much shorter than the average ern technologies: automatic external panies are in the business of developing wait for a donor heart. ECMO also re- defibrillators. The defibrillator is used lifesaving medical products. The ma- quires that the patient take a paralytic to save people from sudden cardiac ar- jority of these companies are very medication which prevents a patient rest, and that is the leading cause of small businesses. Small business we from moving and at the same time that death in this country. Each year, near- tend to measure around here as being obviously weakens the body. ly 325,000 people die from sudden car- those with less than 500 employees. So The Tillmans waited for one of two diac arrest. That is nearly 1,000 deaths what will happen when the Reid outcomes: Either Tiana would receive a a day. Sudden cardiac arrest occurs amendment imposes a tax hike of $20 transplant or she would die waiting on when the heart’s electrical system mal- billion on these innovative medical de- ECMO. functions and the heart stops beating

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Once cardiac ar- Hampton Police Department had al- I was astounded to see this revised rest occurs, the clock starts ticking ready purchased the device. bill still contains $1⁄2 trillion in new and the victim’s proximity to a Increasing the cost of defibrillators taxes, $1⁄2 trillion in Medicare cuts and defibrillator could mean the difference will make it more difficult for commu- mandates and penalties on individuals between living and dying. As many as nities to make this lifesaving invest- and businesses throughout our country 30 to 50 percent of the victims could ment. We already have 62—62— at a time when businesses are strug- survive if such a device is used within defibrillator stations throughout the gling, unemployment is up, and fami- 5 minutes of sudden cardiac arrest. Capitol and the three Senate office lies are trying to make ends meet. Here we have the story then of Mari buildings. So you and I are protected, I wish to talk about the taxes. The Ann Wearda. Mari Ann is a constituent but we are going to put a tax on them revised bill has an additional $25 bil- of the county I have lived my entire 76 for the people in the rest of the coun- lion in taxes than the bill as intro- years in, Butler County, IA. She is also try. It seems as though around here we duced. We have been hearing for weeks a survivor of a sudden cardiac arrest, have one set of morals and ethics for about families who are struggling to thanks to the prompt response of the Capitol Hill and another set of morals pay their mortgage, struggling to find Hampton Police Department and the and ethics for the rest of the country. a job, struggling to pay their utility availability of a defibrillator. Congress clearly understands why hav- bills. Yet what do we find in this new On July 26, 2002, Mari Ann pulled up ing so many of these devices, the im- bill? More taxes and more mandates. to a stoplight in Hampton, IA. Without portance of them and having them on The American people overwhelm- any warning, Mari Ann experienced hand to protect us and to protect our ingly oppose this bill, and just when we sudden cardiac arrest. As she slumped staffs and the million visitors who thought the final product could not get over the steering wheel, her car drifted come to the Capitol. any worse, it does. across the road, climbed the curb, I made a motion that was objected Under the revised bill, the taxes col- knocked over a sign, and came to rest to, so I cannot go through with that lected from individuals who cannot af- against a tree. She was only minutes motion. My motion would have stopped ford health insurance has been raised away from brain damage and death. At this new Federal tax from increasing from $8 billion to $15 billion—almost 11:38 a.m. the police station dispatched the cost of defibrillators and hurting double. Why? Because the penalty for Officer Chad Elness, who arrived at the the chances of placing the devices not purchasing insurance has become scene 2 minutes later, at 11:40. When where they need to be—hopefully, with- more severe. If you cannot afford insur- Officer Elness arrived, Mari Ann was as in 5 minutes of people who need them. ance, the tax is either $750 or 2 percent blue as his uniform, according to his It is a disappointment my colleagues of your taxable income, whichever is own report. on the other side of the aisle would not higher. Officer Elness attached the allow that motion to go through. There are still taxes that begin next defibrillator to Mari Ann and pushed It is a sad state of affairs when the month, less than 2 weeks from now. the button, sending 200 joules of elec- majority is not only blocking the offer- Less than 2 weeks from now in this tricity through her heart. That was one ing of the motions and amendments bill, $22 billion in taxes on prescription of the two shocks that Mari Ann re- that will improve the bill but also try- drug companies will start, and the pub- quired. Between the shocks, the ing to ram through a bill before the lic can expect to see higher prices for defibrillator prompted officer Elness to American people even know what is in medicines. perform CPR. Twice he almost lost it. In 2011, we see $60 billion in taxes on Mari Ann. But by 11:50 a.m., Mari Ann Yesterday, we heard things about Re- insurance companies except for compa- had a pulse and her color was improv- publicans having not offered amend- nies in two particular States. That ing. At 11:52, just 11 minutes after the ments. There are 214 Republican does not seem fair. Fortunately, the defibrillator was turned on, it had amendments at the desk. One would Constitution’s equal protection clause saved her life and was turned off. think we would have a chance to offer may have something to say about this Mari Ann then was taken by heli- more than a dozen or so—I doubt it is gross situation. This will not stand the copter to Mercy Hospital, Mason City, even a dozen at this point—on a bill test of the Constitution, I hope, be- IA, where she received care. One week that is going to restructure one-sixth cause the deals that have been made to later—just one week later—she was of the economy. get votes from specific Senators cannot back home with no permanent damage. I yield the floor. be considered equal protection under Defibrillators are only effective if The PRESIDING OFFICER. The Sen- the law. they are used within minutes of car- ator from Texas. If it does stand and the taxes start in diac arrest, which means that in order Mrs. HUTCHISON. Mr. President, 2011, people who have insurance are to save more lives, there needs to be may I ask, is it 10 minutes—what is the going to pay higher premiums—even more of these devices. But do you know procedural position as of now? higher than what has been projected al- what this bill would do about all that? The PRESIDING OFFICER. The mi- ready. It would increase the cost, meaning nority party controls the time until In 2011, we also see the taxes on med- there would then be fewer 2:30 and there are no individual limits. ical device manufacturers. So the pub- defibrillators. Mrs. HUTCHISON. I thank the Chair. lic can expect to see higher prices for We understand the laws of econom- Mr. President, for weeks we have devices—thermometers, blood sugar ics. If we increase a price, we get less of been debating legislation that will dra- machines, canes, walkers—the things it. If we lower a price, we get more of matically and permanently reform our people need to stay healthy. That is it. So we are going to increase the health care industry. It will impact the another $19 billion in taxes. price of these devices. That would life of every American, and it will add Then there is another round of taxes make it more difficult for police de- to our growing national debt. in 2013: $149 billion in taxes on high- partments, schools, libraries, churches, On Saturday, the majority leader benefit plans; a 40-percent excise tax on and other public places to purchase filed an amendment increasing the size the amount by which premiums exceed defibrillators, or for an individual to of this bill. Early this morning at 1 $8,500 for individuals and $23,000 for have one. If you have to be within 5 a.m., we had a vote to proceed to the families; $87 billion collected from a minutes of their use, you can under- revised bill that makes a mockery of Medicare payroll tax. This tax is actu- stand why they have to be in every po- transparency and public policy. Yet ally $33 billion higher than in the prior lice department, school, library, even though the majority took the op- bill. Individuals earning more than

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Despite the inclusion of in- care. tion to possibly a tax on not having in- surance market reforms in the small-group Cuts in Medicare, and especially the surance or a high-benefit plan. and individual marketplaces, the savings payments for treating low-income sen- Also, $15 billion will be collected by that may materialize are too small for too iors, will disproportionately impact raising the threshold for the medical few and the increase in premium costs are too great for too many. rural hospitals which are the safety net deduction. To receive the medical de- for health care outside the metropoli- That is the tax situation. How about duction, you must now spend 10 per- tan areas. The Texas Organization of the $1⁄2 trillion in Medicare cuts? They cent of your income on medical ex- Rural and Community Hospitals, which are still there. They were in the first penses rather than 7.5 percent. This tax represents 150 rural hospitals in Texas, bill, and they are there now. will impact those who have high med- said in a letter: ical costs or are suffering from a cata- There are $120 billion in cuts to Medi- care Advantage, which we know re- We also fear the Medicare cuts as proposed strophic or chronic illness. could disproportionately hurt rural hospitals This bill taxes those who have insur- duces choices for seniors. In my State which are the health care safety net for more ance and those who do not. All these of Texas, over 500,000 currently en- than 2 million rural Texans. Because of taxes are collected. All the taxes I have rolled enjoy the benefits of Medicare lower financial margins and higher percent- mentioned will be collected before Advantage. That is in my State alone. age of Medicare patients, rural hospitals will there would be the option that is the Millions across the country like Medi- be impacted more than urban hospitals by purpose of this bill. Whatever the in- care Advantage, but many seniors, any reductions in reimbursement. These pro- surance option becomes, it takes effect without a doubt, are going to lose this posed Medicare cuts could have a dev- option. astating effect . . . which could lead to cur- in 2014. All the taxes I have mentioned tailing of certain services. And the closure of start before 2014. Oddly enough, once again, one of the some of these Texas hospitals is a very real Senator THUNE and I had a motion points in the new bill is, there was an possibility. . . . that would have sent this bill back to opt-out for certain States on Medicare How could anyone support a reform the committee and required that every- Advantage cuts. So some States are bill that will result in seniors having thing in this bill start at the same going to have the Medicare Advantage to drive 30, 60, 90 miles and more to get time. So if the program starts in 2014, cuts while other States will not. the care they need—care that was ac- The individual fixes for certain the taxes would start in 2014. Under our cessible in their own community before States, presumably to get the votes of motion, not one dime in taxes would be this bill took effect? paid before Americans are offered the certain Senators, do not pass the test Mr. President, what we have is a bill insurance option in the bill. The mo- of transparency. If you put it in the heavy with tax hikes, Medicare cuts, tion was defeated. Now the Democrats nicest way, it does not pass the test for and government intrusion. This bill is have revised their bill and the taxes fairness, for due process and equal being forced through Congress the collected are even higher than the pre- treatment under the law, and it cer- week of Christmas because everyone vious bill. tainly does not pass the test for what is knows this is not the reform that But do not forget the penalties to the right way for us to pass com- Americans want. The polls are showing businesses that cannot afford to offer prehensive reform legislation. that. We all know polls can have mar- health insurance to their employees. A The other health care cuts in Medi- gins of error, and maybe they are not tax of $750 per employee is assessed. care would be $186 billion in cuts to completely accurate, but the trend in This at a time when unemployment has nursing homes, home health care, and the polls is clear: It has gone from peo- reached double digits. We should be en- hospice providers. ple thinking that health care reform is couraging employers to hire new work- Then there are the cuts to hospitals, a good thing and supporting it, in the ers. Yet this bill imposes $28 billion in approximately $135 billion in cuts to majority, to going down now to the new taxes on employers. hospitals. The Texas Hospital Associa- point where the trend is clear the What will these taxes do to small tion has estimated that hospitals in American people now do not support businesses which create 70 percent of my State will suffer almost $10 billion this bill, they would rather have noth- the new jobs in our country? In a letter in reduced payments. ing, according to the latest polls, and sent to the majority leader, the Small I have a letter from the Texas Hos- have Congress start all over and do Business Coalition for Affordable pital Association that outlines their what they hoped it would do, and that Health Care stated: concerns with these cuts and this bill is bring down the cost of health care With its new taxes, mandates, growth in and they are very concerned. Here is not have this be a big government in- government programs and overall price tag, one of the quotes from their letter. The crease in debt, cuts to Medicare, and the Patient Protection and Affordable Care Texas Hospital Association says: Act— increases on taxes to small business With a significant reduction in payments, and families, especially at this time in The bill we are discussing— hospitals may be forced to reduce medical costs too much and delivers too little. . . . services. [H]ospitals . . . may be forced to our country’s economic period. Any potential savings from those reforms close or merge with another hospital, or se- My Republican colleagues and I have are more than outweighed by the new taxes, verely reduce the services they provide to tried to offer fiscally responsible alter- new mandates and expensive new govern- their community. Essential services, such as natives to reform, allowing small busi- ment programs included in this bill. maternity care, emergency services, med- nesses to pool together, increase the That letter is signed, in addition to ical-surgical services or wellness programs size of their risk pools, which will the Small Business Coalition, by asso- may be reduced or entirely eliminated. bring premiums down. If you have an ciations such as the Farm Bureau, As- I have talked with so many hospital exchange it would be fine unless you sociated Builders and Contractors, As- administrators and people on hospital have so many mandates, such as we see sociated General Contractors of Amer- boards, and they are very concerned in this bill, that are going to cause the ica, the National Association of Home- about the cuts in this bill because most prices to stay up and even go higher be- builders, the National Association of of them are on very thin margins. They cause of all the taxes on the underlying Manufacturers, the National Auto- are struggling, especially in our rural companies that are providing the mobile Dealers Association, the Na- areas. They are very worried there are health care. tional Retail Federation, and more. going to be shutdowns of hospitals Creating an online marketplace free The National Federation of Inde- throughout our State and certainly our from mandates and government inter- pendent Business, which is the voice of country. ference where the public can easily

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As a matter of fact, the bartering for suading them to vote for cloture, which Offering tax credits to individuals votes for cloture, the special sweet- has caused some people on the blogs and families who purchase insurance heart deals with drug industries, with and the Internet to call it ‘‘Cash for on their own, that is a bill that we Senators, in order to get the 60 votes Cloture.’’ In order to get 60 votes for have put forward. Five thousand dol- last night, does nothing more than con- cloture, we know one of the first exam- lars per family would cut the cost and firm the worst fears and cynicism the ples of that was the so-called ‘‘Lou- make it affordable without any govern- American people have about the way isiana purchase.’’ Charles Kraut- ment intervention that would be nec- Washington works. hammer said it well: essary. We know this bill is a direct result of Well, after watching Louisiana get $100 Of course, medical malpractice re- many special deals with special inter- million in what some have called ‘‘The Lou- form could take $54 billion out of the est groups and their lobbyists. We isiana Purchase,’’ she ought to ask for $500 cost of health care by stopping the friv- heard the President say when he cam- million at least. And that’s because Obama said he would end business as usual in Wash- olous lawsuits, or at least limiting paigned that he wanted to have a ington. So it’s a new kind of business as them. Yet Republicans were really not transparent process; that this would usual. at the table. The bill was written in a take place in front of C–SPAN and at a In other words, I guess the price has room, with no transparency, no C– roundtable so people could see who was gone up. But as one business leader in SPAN cameras, and no Republicans. making arguments on behalf of the Louisiana points out, notwithstanding We did not have input into this bill. drug companies and the insurance com- the special sweetheart deal for the That is why it is a partisan bill. That panies. But that rhetoric conflicts with State of Louisiana directing $300 mil- is why the vote last night—or this the reality, where the drug companies lion to the State, the Medicare expan- morning at 1 a.m.—was completely, 100 and the insurance companies and oth- sion alone will result in the taxpayers percent partisan. Why would a Repub- ers were negotiating behind closed and the people of Louisiana being a net lican vote for a bill that goes against doors for sweetheart deals that ulti- loser. every principle we have—higher taxes, mately ended up getting 60 votes. We also know in order to get 60 votes, higher mandates, and cuts in Medi- So it turned out it was the Obama ad- the majority leader had to cut a deal care—and in which we had not one ministration that cynically said one with a Senator from Nebraska—the amendment pass? We offered amend- thing during the campaign and then, senior Senator from Nebraska—in ments, but there were hundreds of when it came to actually passing legis- order to get the vote for cloture. It has amendments left on the table that we lation, did completely the opposite. been widely reported that the meeting were closed out of offering because of This is tragic, in my view, Mr. Presi- with the senior Senator from Nebraska the rush to pass this bill before Christ- dent. The American people want to be- took place for 13 hours behind closed mas. lieve in their government. They want doors, after which they negotiated Mr. President, Americans asked for to believe their elected leaders are try- some language which, purportedly, no reform; they deserve it. This bill is not ing to do their best on behalf of the longer allowed the use of tax dollars to the reform Americans hoped to get American people. But this process con- pay for abortions. But according to the from a Congress that should have acted firms their worst suspicions. No won- Conference of Catholic Bishops and responsibly but did not. der public opinion of Congress is in the other pro-life groups, the language is Mr. President, I yield the floor. toilet. completely ineffectual and it restores The PRESIDING OFFICER. The Sen- Rather than listening to the Amer- or actually produces taxpayer-paid-for ator from Texas is recognized. ican people, the creators of this bill abortions for the first time in three Mr. CORNYN. Mr. President, as my started cutting deals with special in- decades. colleagues on this side of the aisle, I terests first and cut those deals early. What else did the senior Senator voted against the Reid health care bill The White House struck a deal with from Nebraska get? Well, the State of last night because it cuts $470 billion the pharmaceutical industry, as you Nebraska purportedly got a free ride from Medicare to create a brand-new know, which produced in part, as the from Washington’s new unfunded Medi- entitlement program that will cost ap- New York Times reported, about $150 care mandates on the States. But, of proximately $2.5 trillion over the next million in television advertising sup- course, we know every other State ends 10 years—a price we cannot afford. It porting this bill. This deal got 24 up paying for that sweetheart deal the increases premiums for American fami- Democrats when we were debating the senior Senator got for Nebraska. What lies who currently have health insur- issue of drug reimportation to switch do Nebraskans think about it? Well, ance and who are struggling to make their votes from their previous position ask the Governor—Governor Dave ends meet during tough economic against drug reimportation earlier this Heineman—who said yesterday he had times. It increases taxes on small busi- month. nothing to do with that bill, and called nesses and individuals, which is a ter- Notwithstanding all the rhetoric the overall bill bad news for Nebraska rible idea, particularly at a time when about insurance companies, basically and bad news for Americans. Governor our economy is struggling and our job this is a sweetheart deal with insur- Heineman said Nebraskans did not ask creators are struggling to be able to ance companies because insurance for a special deal, only a fair deal. keep people on their payroll and pos- companies will get $476 billion of your We also know that in order to get 60 sibly expand their payroll and hire peo- tax dollars and my tax dollars to pay votes, the majority leader had to cut a ple back and bring down the unemploy- for the subsidies and the insurance pro- special deal for Vermont. One Senator ment rate. vided in this bill. from Vermont threatened to vote I want to talk about the way this bill The hospital industry cut a special against the bill, but then, lo and be- came to pass—at least the cloture vote deal that provided them an exemption hold, the managers’ package included this morning at 1 a.m.—and I want to from the payment advisory board. $600 million benefiting only that one talk about the process. I recall when Then there were groups such as AARP State. The Senator who threatened to Senator Obama was running for Presi- that purport to serve seniors as a pub- vote no decided to vote yes after that dent, he talked about wanting to lic interest but, as we know, primarily special deal was concluded. change politics as usual in Washington, pocket money as a result of the sale of The New York Times lists several DC. But I have to tell you, the major- insurance policies—insurance policies other sweetheart deals that produced

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00020 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32926 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 this monstrous piece of legislation. The doubt about it, this bill takes the came to light over the weekend as the intended beneficiaries, though, in power from individual Americans to managers’ amendment was released many instances, were identified in a make their own health care decisions and analyzed. vague and sort of cryptic way, such as: and transfers that to Washington, DC, Less than 24 hours after the an- Individuals exposed to environmental and this new low level of politics as nouncement of the special carve-out health hazards recognized as a public usual. for Nebraska, with virtually no warn- health emergency in a declaration According to one recent poll that was ing, no preparation to speak of, 2,000 issued by the Federal Government on reported today, Rasmussen, for one people gathered in Omaha, NE, Nebras- June 17. Well, there is only one State State I will not mention by name, kans who, in one voice, cried foul. Ne- that would qualify for that, notwith- found only 30 percent of the respond- braskans are frustrated and angry that standing this sort of vague description ents to this poll favor this health care our beloved State has been thrust into designed to hide the ball and obscure bill and 64 percent are opposed. The the same pot with all of the other spe- what was actually happening through Senators from those States voted for cial deals that get cut here. In fact, another sweetheart deal as part of this the bill where only 30 percent of their they are outraged that a backroom bill. constituents reportedly support the deal for our State might have been Another item in the package would bill. That is not the only example. what puts this bill across the finish increase Medicare payments to doctors You can only ask yourself why in the line. and hospitals in any States where at world would Senators vote for a bill You see, I fundamentally believe that least 50 percent of the counties are when two-thirds of their constituents if this health care bill is so good, it ‘‘frontier counties,’’ defined as those are opposed to it. Who must they be should stand on its own merits. There having a population density of less listening to? Are they listening to the should be no special deals, no carve- than six people per square mile. people whom they represent and who outs for anyone in this health care Then we know there was another $100 sent them here to Washington to rep- bill—not for States, not for insurance million sweetheart deal for an resent them or are they listening to companies, and not for individual Sen- unnamed health care facility affiliated the special interests or have they de- ators. with an academic health center at a cided somehow that they have become I stand here today and I find it is public research university in a State miraculously smarter than their con- enormously ironic that advocates for where there is only one public medical stituents and they know what is better this bill, who worked overtime to vilify and dental school. The Associated for their constituents than what their insurance companies, in the last hours Press reports that the State that quali- constituents know themselves? of putting this bill together struck a fies for that special deal is the State of This debate is not over. There is still special deal with two insurance compa- Connecticut, where the senior Senator a chance to vote against this bill. As nies in Omaha, NE, that they would be currently is in a tough reelection fight. Senator MCCONNELL said last night, carved out of their responsibility in When asked about these special deals any single Senator on the other side of this bill to pay taxes. I find it painful in the managers’ amendment, the re- the aisle can stop this bill or every one to even acknowledge that happened. sponse of Mr. Axelrod—the architect of who votes for it will own it. I said at the beginning of this debate the campaign strategy for this admin- I yield the floor. that changes of this magnitude, affect- istration to bring change to Wash- The PRESIDING OFFICER (Mr. WAR- ing one-sixth of our economy, must be ington—was pretty telling. He said: NER). The Senator from Nebraska. fair and they must be believed to be That is the way it has been; that is the Mr. JOHANNS. Mr. President, let me fair by the people. The special deal for way it will always be. start my comments today by compli- Nevada was wrong. I said that. In fact, Well, maybe in Chicago, but not in menting the Senator from Texas. I one of the six reform principles I pub- my State, and not in the heartland and thought he did an excellent job of shin- licly outlined and took out to townhall the vast expansion of this great coun- ing the light on something that is now meetings I stand by today. It simply try where the American people want us gathering a lot of attention because said: No special deals. to come and represent our constituents the managers’ amendment is out and The special deal for Nevada was and vote for what is right in terms of we can read the words and we can start wrong, as is the carve-out for Lou- policy, not what kind of sweetheart to understand the special deals that isiana. And the same applies for the deals we can eke out at the expense of were cut to get the votes to make this backroom deal that was struck for my the rest of the American people. happen. I applaud the Senator for State, the great State of Nebraska. The very thing that is happening standing here so courageously. All of the special deals should be re- with this health care bill demonstrates My State, the great State of Ne- moved from this legislation. If this bill why Washington takeovers are such a braska, has been pulled into the de- cannot pass without the carve-outs and terrible idea because instead of health bate. I want to start out today by say- the special deals, what further evidence care decisions being made between pa- ing here on this Senate floor that I am could we possibly need to draw the con- tients and doctors, health care deci- enormously proud of my State, prob- clusion that this is enormously bad sions are overcome through a political ably like all Senators in reference to policy? If you literally had to sit down process where elected officials choose their State. I am enormously proud of in the last hours of negotiations and winners and losers. the people of Nebraska. I have gotten strike a special deal, do we need any Politics has become a dirty word out- to know them well. I was their Gov- other argument about how bad the pol- side the beltway, and certainly we can ernor. On a more localized basis, I was icy of this bill is for my State and the understand why. This process has only also the mayor of Lincoln. I date my citizens of Nebraska? reconfirmed in the minds of many peo- time in public service back to the time Our Governor said it well: Nebras- ple that what we are doing here is not when I was Lancaster County commis- kans don’t want a special deal. You the people’s business but protecting sioner and a city council member in see, I went around the State for special interests and special sweetheart Lincoln. These are good, decent, honor- months doing townhalls and listening deals. Rather than making decisions able people who are always looking to to Nebraskans. They do not want a spe- about what is best for the American try to figure out the right way of doing cial deal. No Nebraskan came up to me people, this deal has been driven by things. and said: MIKE, give me a special deal. deals with special interest groups and I stand here today to acknowledge You see, their request is simple: They lobbyists. Rather than listen to con- that and to tell all Nebraskans how want to be able to see the doctor of stituents, individual Senators have de- proud I am to be here today. But I rise their choice and to keep the current cided that their votes should be traded today to share with my colleagues the plan they have. They want our job cre- for tax dollars and other sweetheart reactions of Nebraskans to the special ators, our small businesses, to get our benefits that go to their States. No deal that got cut for Nebraska that economy moving and create jobs in our

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00021 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32927 communities from large to small, free time for a long period of time. This bill in Chester, New York, as the ‘‘1st Lieu- of the $1⁄2 trillion in taxes and fees this passed by unanimous consent. tenant Louis Allen Post Office’’, was bill will keep on our employers. When rule XLIV was passed, the the- ordered to a third reading, read the The managers’ amendment does ory behind it was that we ought to third time, and passed. nothing to change the core problems have total transparency on earmarks. f with this bill. The nearly $500 billion in It applies to floor amendments such as Medicare cuts will be devastating to the pending Reid bill. It requires the COACH JODIE BAILEY POST Nebraska. No special deal with an in- sponsor of the amendment to provide a OFFICE BUILDING surance company is going to make Ne- list of earmarks in that amendment. The bill (H.R. 3072) to designate the braskans feel better about that. No Earmarks are provisions that provide facility of the United States Postal special deal to make the State budget limited tax benefits. Those words, Service located at 9810 Halls Ferry look better is going to make Nebras- ‘‘limited tax benefits,’’ are words out of Road in St. Louis, Missouri, as the kans feel any better about the Medi- the rule. Another substitute language ‘‘Coach Jodie Bailey Post Office Build- care cuts and the impacts on our hos- for limited tax benefits is ‘‘congres- ing’’, was ordered to a third reading, pitals, our nursing homes, our home sionally-directed spending items’’ or read the third time, and passed. health care industry, and our hospice ‘‘earmarks,’’ as they are generally re- industry. Nationally, Governors—Re- ferred to by the public at large. f publicans and Democrats—have Given what a priority the new rule stepped forward to say they cannot af- passed in 2007 was given and the impor- ARMY SPECIALIST JEREMIAH ford the unfunded mandates that come tance of it, one would expect that the PAUL MCCLEERY POST OFFICE from Washington and drive their budg- majority leader would be making every BUILDING ets into the red. effort to comply with it. One would The bill (H.R. 3319) to designate the The special deal struck on abortion is think he would be wanting to set a facility of the United States Postal enormously tragic and insufficient. It good example in complying with the Service located at 440 South Gulling breaks my heart. This is a far cry from rule and disclosing these earmarks. In Street in Portola, California, as the the 30 years of policy by this U.S. Gov- order to assure transparency of these ‘‘Army Specialist Jeremiah Paul ernment. You see, when this is done very narrow provisions, such as what McCleery Post Office Building’’, was and over, what we will be reporting to Senator JOHANNS just referred to, to ordered to a third reading, read the our citizens is that taxpayer funds will get the votes of specific Members of third time, and passed. fund abortions if this bill passes. You the majority party who probably would f see, no watered-down accounting gim- not have voted for this bill, you would mick will convince the pro-life commu- think that ought to be made public. PATRICIA D. MCGINTY-JUHL POST nity in my State otherwise. In fact, That is what rule XLIV is about. Of OFFICE BUILDING they have publicly said they feel be- course, that burden under that rule is The bill (H.R. 3539) to designate the trayed. on the sponsor to provide the list. facility of the United States Postal I will wrap up with this. This bad Once again, I am going to ask the Service located at 427 Harrison Avenue deal is not sealed. There is time for Democratic leadership to comply with in Harrison, New Jersey, as the ‘‘Patri- truly pro-life Senators to stand tall the Honest Leadership and Open Gov- cia D. McGinty-Juhl Post Office Build- and say no. There is still time for prin- ernment Act. ing’’, was ordered to a third reading, cipled Senators to reject the carve-outs The PRESIDING OFFICER. The time read the third time, and passed. and to cast aside the bad backroom for the minority has expired. deals. There is still time for Senators The Senator from Montana. f to listen to the people and reject reck- f less Federal policy. CLYDE L. HILLHOUSE POST Fair treatment is not too much to THE CALENDAR OFFICE BUILDING ask of Washington. I know in my Mr. BAUCUS. Mr. President, I ask The bill (H.R. 3667) to designate the State, that is what they are asking for. unanimous consent that the Senate facility of the United States Postal I will firmly stand behind any Senator proceed en bloc to the following bills: Service located at 16555 Springs Street who has the courage to stop this train Calendar Nos. 235 through 242; that the in White Springs, Florida, as the wreck. I will be the first to lead the ap- bills be read a third time and passed en ‘‘Clyde L. Hillhouse Post Office Build- plause. I am confident that the stand- bloc, the motion to reconsider be laid ing’’, was ordered to a third reading, ing ovation for that courageous Sen- upon the table, with no intervening ac- read the third time, and passed. ator will extend all the way back to tion or debate, and that any state- f Nebraska and it will be deafening. ments relating to these matters be I yield the floor. printed in the RECORD. W. HAZEN HILLYARD POST OFFICE Mr. GRASSLEY. Mr. President, how The PRESIDING OFFICER. Is there BUILDING much time remains? objection? The bill (H.R. 3767) to designate the The PRESIDING OFFICER. There is Mr. GRASSLEY. I object. I don’t facility of the United States Postal 21⁄2 minutes. know what this is all about. Has this Service located at 170 North Main Mr. GRASSLEY. I would think one of been cleared with our side? the things we would have seen from the Street in Smithfield, Utah, as the ‘‘W. Mr. BAUCUS. These are post office Hazen Hillyard Post Office Building’’, majority at this point is a list of what bills. the last two Senators were talking was ordered to a third reading, read the Mr. GRASSLEY. I withdraw my ob- third time, and passed. about, all the earmarks that are in this jection. bill, because I asked for a parliamen- The PRESIDING OFFICER. Without f tary inquiry yesterday—I am not going objection, it is so ordered. CORPORAL JOSEPH A. TOMCI POST to ask that again—but, as we said yes- The Senate proceeded to consider the OFFICE BUILDING terday, rule XLIV was adopted as part bills. of a major ethics and reform legisla- f The bill (H.R. 3788) to designate the tion, adopted in 2007. It was part of the facility of the United States Postal Honest Leadership and Open Govern- 1ST LIEUTENANT LOUIS ALLEN Service located at 3900 Darrow Road in ment Act. The Democratic leadership POST OFFICE Stow, Ohio, as the ‘‘Corporal Joseph A. made it the first bill to be introduced The bill (H.R. 2877) to designate the Tomci Post Office Building’’, was or- when they took the majority in 2007, facility of the United States Postal dered to a third reading, read the third taking control of Congress for the first Service located at 76 Brookside Avenue time, and passed.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00022 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32928 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 JOHN S. WILDER POST OFFICE Republicans are. If they had a bill they wellness. In the past I have said many BUILDING were supporting and that was sup- times that we don’t have a health care The bill (H.R. 1817) to designate the ported by all of them, such as the bill system in America. We have a sick care facility of the United States Postal we have here which is supported by 60 system. When you think about it, if Service located at 116 North West Democrats, I think then you could find you get sick, you get care. But pre- Street in Somerville, Tennessee, as the some reason for meeting and working cious little is spent out there to keep ‘‘John S. Wilder Post Office Building’’, things out. But since there is no one on one healthy in the first place. So peo- was ordered to a third reading, read the that side who has a comprehensive pro- ple get sick. You go to the doctor, the third time, and passed. posal, it is hard to do that. We have hospital. We patch and fix and mend had to kind of plow ahead as best we and try to make them well. f can. We have not done this alone. In Your mother was right, you know: SERVICE MEMBERS HOME our committee, we met for 13 days. We Prevention is worth a pound of cure. OWNERSHIP TAX ACT OF 2009 had 54 hours of markup. No amendment We have fallen far short of that in this The PRESIDING OFFICER. The Sen- was denied. Republicans offered over country. There is a remarkable array ator from Montana. 200 amendments. We adopted 161 of of provisions in this bill that promote Mr. BAUCUS. I yield 20 minutes to them. That is pretty good. Yet in the wellness, disease prevention, and public the chairman of the HELP Committee, end, every Republican voted against it. health. Together they will move us Senator HARKIN, and 18 minutes to the So it is not as if we didn’t try and we from a sick care society into a genuine Senator from Colorado, Senator BEN- didn’t hold out an olive branch to work wellness society, into a true health NET. with people to get a bill that was truly care system, not just sick care. What The PRESIDING OFFICER. The Sen- bipartisan. We did in our committees, better way to reform our health care ator from Iowa. both the Finance and HELP Commit- system than to restrain health care Mr. HARKIN. Mr. President, I guess I tees. Now it has come down to fear and costs by helping Americans to prevent can say we crossed the Rubicon last anger on the other side and some chronic diseases, stay healthy and out night at 1 o’clock. Reading some of the nitpicking. of the hospital in the first place. Right My friend from Iowa—and he is truly press reports, of course, most of the now, as we have heard so many times, my friend—was talking about some news didn’t have it because it occurred we spend more than $2 trillion each provisions put in the bill for special at 1 a.m. Some of the different reports year on sick care. But 4 cents of every reasons and so forth. I admit fully and have been online this morning. It oc- dollar is invested in prevention and openly that I was part of that. Did I curred to me that a lot of people are public health. I submit this is a major put something in the bill that was sort missing the overall importance of what reason why Americans spend twice as of particular to my State of Iowa? Yes, happened last night. We can get into much per capita on health care as Eu- I did. But it doesn’t just affect Iowa. the fine tuning and the nitpicking and ropean countries, but we are twice as There are several States in which we sort of the fear and the anger I hear sick with chronic disease. We spend have hospitals that are not as big as from the other side. Every time I listen twice as much as Europe on health the big hospitals with the volume. to speeches over there, with the excep- care, but we are twice as sick with They are not so small that they are tion of the last speaker, almost all the chronic diseases. speeches I hear from the other side, it low-volume hospitals that get help. is fear, be afraid, be afraid. It is some They are kind of in between. They call The good news is that by ramping up built-up anger over there. I think what them tweener hospitals. We have eight the emphasis on wellness and preven- happened last night is, we crossed a de- of them in Iowa: at Grinnell, Keokuck, tion, we have tremendous opportuni- marcation line, the demarcation line of Spencer Municipal, in Carroll, St. An- ties to both improve the health of the which on one side health care is a thony Regional; Muscatine; Fort Madi- American people and to restrain health privilege. We have been on that side of son; and Lake Regional Hospital at care spending. That is the aim of this the line for a long time. On the other Spirit Lake. There are a number of bill which makes significant new in- side of that line, health care is a right. these in the United States. I forget the vestments in prevention. For example, We stepped across that line last night. total number; not a large number, they our bill would ensure that seniors have We are now in the process of saying just fall in a place where they are too access to free annual wellness visits health care is a right, an inalienable small for the big and too big for the and personalized prevention plans right of every American citizen. small. As a result, they have been get- under Medicare. We have never had Is that what so upsets my friends on ting a bad deal from Medicare reim- that. For the first time seniors will the Republican side? I don’t know. bursement. There is a fix in this bill have access to free annual wellness vis- Something is upsetting them. Because that will allow them to get adequate its and personalized prevention plans this is a momentous change we are reimbursement. I don’t see anything under Medicare. That is a big deal. So doing. wrong with that. It is fixing a specific many seniors today, if they get sick, go I keep hearing from Republicans they problem that the bureaucracy can’t to the doctor and get more pills. Now want us to deal in a bipartisan way. We seem to quite get fixed. That is in the they will be able to go in, have their tried all this year, both in the HELP bill. I make no bones about having put annualized checkup, see what is wrong, Committee and in the Finance Com- that in there. I think it is a good deal. and have a personalized prevention mittee. Senator BAUCUS bent over It is something that is going to help a plan for each person under Medicare. backward to accommodate. But at lot of hospitals, not only in Iowa but a It will also encourage States to im- every turn, Republicans said no, no, no, few other States. prove coverage and access to rec- no, no—all year long. How can you be One of the things I wish to talk about ommended preventative services and bipartisan when the other side has today is something I have been on for immunizations under Medicaid. At a nothing to offer? There is no bill on the many years, and that is the huge minimum, States will provide Medicaid Republican side. There is a bill. It has amount in this bill on prevention and coverage for comprehensive tobacco about nine cosponsors—Senator wellness. It has not been written about cessation services for pregnant women. COBURN, Senator BURR, maybe seven a lot. People have been focused on the That is just the start. Right away, at a others, but not every Republican is on public option and the abortion issue minimum, they have to do that. In ad- that. I hear bits and pieces of this and and a few other items such as that. dition, the bill requires insurance com- that every time I hear these speeches. Perhaps one of the most profound parts panies to cover recommended preven- Most of it is attacking what we have of this bill and the one I believe will do tive services with no copayments or done. I hear nothing positive from more to bend the cost curve, as they deductibles. This is critical because we their side. It is very hard to deal with say, than any other single thing is the know that all too often people forgo a party that is in total disarray as the provisions dealing with prevention and their yearly checkups or essential

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00023 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32929 screenings because either their insur- health. We also have to realize that But in this bill we have made a great ance companies don’t cover them or be- wellness and prevention must be truly start. We have laid a great foundation. cause they have high copays and comprehensive. It is not only about I am just thrilled so many of the deductibles. what just goes on in the doctor’s office; wellness and prevention initiatives I Another critical element in the bill it also encompasses community-wide have championed for so many years are essential to a sustainable push for wellness programs, about which I just included in this bill. wellness is the creation of a prevention spoke, things such as building bike As I look forward to going to con- and public health trust fund. Typically paths, walking trails, getting junk food ference, we look forward to working prevention and public health initia- out of our schools, out of the vending with the House to strengthen it even tives are subject to unpredictable and machines, making our school break- more and to put more emphasis on unstable funding. This means that im- fasts and lunches more nutritious, in- wellness and prevention. portant interventions, things such as creasing the amount of physical activ- Just about an hour ago or so, we had education about nutrition and assist- ity our children get, and so much more. a press conference with the president- ance for smokers who want to quit, Some of this is going to be addressed elect of the American Medical Associa- often go unfunded from one year to the in other bills. For example, next year, tion, Dr. Wilson. I am proud of the fact next. They get funded a little bit one in the Agriculture Committee, we will that the American Medical Association year or cut the next; funded a little bit be reauthorizing the child nutrition has now endorsed our bill. As I said at the next year, cut the next. The pre- bill. That deals with school lunches the time, I said the doctors of America vention and public health fund in this and school breakfasts. We need a major have examined this bill, and they have bill will provide an expanded and sus- effort there to make our lunches and made the right prescription: Pass it. tained national investment in pro- our breakfasts more nutritious for our Pass the health care reform bill. grams that promote physical activity, kids in school. But Dr. Wilson, in his statement, improve nutrition, and reduce tobacco Next year, in the committee I chair, made particular note of the wellness use. We all appreciate that checkups the HELP Committee, we are going to and prevention programs we have in and immunizations and other clinical reauthorize the Elementary and Sec- this bill. He did not say this, but I was services are important. But this bill ondary Education Act, the so-called No thinking, when he was talking, that it also recognizes that where Americans Child Left Behind Act. There are a lot made sense. Doctors want to keep peo- live and work and go to school also has of things we are going to be doing on ple healthy. They do not want to see a profound impact on our health. That that. I see one of our committee mem- people go to the hospital. They would is why a number of provisions in the bers, the Senator from Colorado, Mr. rather be working with their patients bill focus on creating healthier com- BENNET, in the Chamber, a former su- one on one. How can they structure a munities with better access to nutri- perintendent of schools, who is going patient’s profile so the patient stays tious foods as well as safe places to en- to play a key role in helping get that healthy, does not get sick so often? gage in physical activity. Elementary and Secondary Education That is what Dr. Wilson was talking A 2007 study by the Trust for Amer- Act through and refined and brought about: letting doctors practice medi- ica’s Health found major savings from up to date where we will make some cine in a way that focuses on a person’s community-based prevention programs changes. health and keeping them healthy. designed to increase levels of physical But there is one other part of that As President Obama said in his activity, improve nutrition, and reduce bill we have to focus on; that is, the speech to Congress early this year: smoking rates. This study concluded amount of physical activity kids get in [It is time] to make the largest investment that a national investment of $10 per school. I talked many times both to ever in preventive care, because that’s one of person per year in these kinds of com- Secretary Duncan and, before him, to the best ways to keep our people healthy and munity-based programs could yield net Secretary Spellings about this idea of our costs under control. savings of more than $2.8 billion annu- No Child Left Behind. If we are not That was the President of the United ally in health care costs in the first 1 going to leave kids behind in terms of States in his State of the Union mes- and 2 years, more than $16 billion sav- their writing and their math and their sage. Well, President Obama has it ings within 5 years, and nearly $18 bil- English, how about not leaving them right. It is one of the best ways to keep lion savings annually within 10 to 20 behind in terms of their health? Yet re- our people healthy and our costs under years, starting at $10 per person per cess is gone. I saw a statistic this year control, and that is a big part of this year. that said 80 percent of elementary bill. I do not know—I have not listened More generally, this bill aims to give school kids in America today get less to every speech made by the Repub- Americans the tools and information than 1 hour of physical exercise a week licans on the other side—but I hardly they need to take charge of their own in school—80 percent get less than 1 ever hear them talk about this, but it health. For example, it requires large hour a week. is a very important part of the bill. chain restaurants to post basic nutri- Mr. President, I do not know about So, Mr. President, we are changing tion information on the menu so con- you, but I remember when I was in the paradigm. We are going to extend sumers can make healthy choices. That school, in elementary school, we had quality, affordable health coverage to is in this bill. It will start next year. an hour a day for recess. We had 15 nearly every American. We are going The bill also focuses on prevention minutes in the morning, 15 minutes in to transform ourselves into a genuine and public health needs of a number of the afternoon, and a half hour at lunch. wellness society, and we are going to generally overlooked populations, in- So there was 1 hour every day, and we give our citizens access to a 21st-cen- cluding children, individuals with dis- had to go out and do stuff. We couldn’t tury health care system, one that is fo- abilities, Americans living in rural sit around and play with Game Boys cused on helping us to live healthy, ac- communities, and certain ethnic mi- and things like that. So we got an hour tive, and happy lives. norities. For many months I have made a day of physical exercise. Well, we Mr. President, I yield the floor. the case that it is not enough to talk need to reinvigorate our schools to The PRESIDING OFFICER. The Sen- about how to expand insurance cov- make sure they get that physical exer- ator from Colorado. erage, how to pay the bills—those are cise. Mr. BENNET. Mr. President, I would important—but it makes no sense to So we have done a lot in this bill to like to first thank the Senator from figure out a better way to pay the bills move this paradigm toward a health Iowa for his leadership over many for a system that is dysfunctional, in- care society rather than a sick care so- years, especially on prevention and effective, and broken. ciety. There is more to do, as I said, in wellness, and to see so much of this bill We have to change the health care both the Education bill next year and devoted to that is a real testament to system itself, beginning with a sharp in the Agriculture Committee in terms his efforts. So I thank the Senator for new emphasis on prevention and public of the child nutrition reauthorization. that.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00024 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32930 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 Mr. President, a number of years ago, for Members of Congress than it is in 40,000 in the months we have debated I left a rewarding job in business be- what our constituents have to say, a this bill. On average, 111 Coloradans cause I had a chance to lend a hand to Washington that is more concerned have lost their health insurance every my community during a very difficult with the millions being spent by big in- single day. This number will only get time in Denver. The economy was slow surance companies than the thousands worse if we do nothing. Our State has and the city was facing a record budget of dollars being lost by working fami- spent $600 million in the last year deficit. Our great mayor, John lies who are struggling to pay for cov- alone on uncompensated care. Hickenlooper, asked me to come be his erage. Colorado’s working families suffered chief of staff. It was not a glamorous Columnists opposed to reform have double-digit health insurance cost in- job, but it was rewarding because we criticized me for saying that I am will- creases year after year for the last dec- got results—not by seeking out what ing to lose my seat to enact meaning- ade. Many families have made terrible divided the people of Denver, who were ful health care reform. Now I am being sacrifices—no longer investing in their going through a very rough time, but asked why I did not negotiate a special children’s futures, saving for a home, by reaching out time and time again to deal with leadership. In fact, there was or carrying crushing credit card bal- what the mayor called ‘‘our alignment a report this morning criticizing me ances—all to pay for health care. of self-interest.’’ because the National Republican Sen- Small businesses pay 20 percent more We fixed the city’s budget, and then atorial Committee was rejoicing that I for health insurance than large busi- I had the chance of a lifetime to be- did not ask for special favors. Only in nesses do just because they are small. come the superintendent of public Washington would someone be at- I think back to the Coloradans who schools and serve our children and the tacked for not negotiating a backroom shared their stories with me during people who work so hard every day to deal. Just because others choose to en- this debate. support them. I came away from that gage in the same tired Washington rit- I remember Bob and Deb Montoya of experience believing that much of the uals does not mean I have to. Pueblo. They were torn between pro- Republican and Democratic ortho- So I have a message for the col- viding health care for their small busi- doxies relating to public education are umnists, the political professionals, ness employees and keeping their busi- essentially useless to our children—and and those back home: I am not happy ness afloat. Last year, their business maybe worse—and that Washington as about the backroom deals. I am not paid out $36,000 to cover two families a whole has absolutely no clue about happy that the public option was held and one employee. They could not af- what is going on in America’s class- hostage by people in our own party. I ford to give their other 12 employees rooms. do not support rewarding delay with health care or they would be literally So it is fair to say I did not come to special deals. I will let others justify forced out of business. So they dropped Washington with a partisan ax to their vote and their tactics. coverage for the 12 employees to keep grind. As is probably obvious to every- As for me, I am voting to provide their doors open. one around here—for good or for ill—I coverage to 840,000 uninsured Colo- Hollis Berendt owns a small business am not a career politician. I did not radans, voting to extend Medicare for in Greeley and told me about her come here to win political points so our seniors and provide free preventive daughter Abby who graduated from that someone else could lose. I am not care for everyone, voting to close the Colorado State University in 2004 and interested in that. I am here as the fa- prescription drug loophole and provide found a job in New York with a large ther of three little girls with an abid- tax cuts to small business, voting to company. Her daughter’s company ing concern we are at risk of being the make health care more affordable and made her wait a year before she was el- first generation of Americans to leave eliminate exclusions based on pre- igible for health insurance, and during less opportunity to our kids and our existing conditions, voting for health that time Abby was diagnosed with grandkids than our parents and grand- care reform that is fully paid for. ovarian cancer. Hollis took out a sec- parents left us. That prospect is shame- The people in my State and in our ond mortgage to pay for her daughter’s ful. country deserve better than a politics bills and told me: We are not the only Americans who that cares more about lobbyists and This experience brought to light, all too have been working weekends and late talk show hosts than the people we rep- clearly, how close we all are to losing every- into the night recently. There are peo- resent. I am committed to delivering thing due to a health issue. ple in small towns and big cities all on that despite what the political ex- I have spoken here before about a across America doing jobs much harder perts have to say. And, in the end, young boy named Alex Lange. Alex’s than ours, who are taking an extra when the dust settles and the stories parents’ insurance company refused to shift before Christmas so they can af- focus more on substance and process, I cover Alex because he was 4 months old ford that extra gift beneath the tree— am confident Coloradans will see it the and 17 pounds. They said he had a pre- Americans who are unemployed in this same way. existing condition, at 4 months, of obe- savage economy and still trying to I also commit to the people of Colo- sity. make sure the kids know Santa re- rado and the people of this Chamber Then there was 2-year-old Aislin membered them. that I will do everything I can to make Bates, whose parents’ insurance com- These same people are reading their sure this bill is fully paid for. That is pany denied her coverage because she papers and watching their televisions why I submitted an amendment that was underweight. One child too big, the wondering what in the world we are will ensure that health care will help other too small. Today in America, you doing here in Washington. All they see pay down the deficit by forcing Con- have to be just right to get insurance. are talking heads yelling at each other gress to make adjustments if reform There was Peggy Robertson of Gold- on cable news, needless partisanship does not meet the cost estimates we en, CO, who was told she could not re- paralyzing their government, and even have projected. ceive coverage unless she was steri- people praying that Senators will not I urge my colleagues and the leader- lized, Mr. President. She came and be able to make votes. ship in the Senate to see to it that this bravely testified in Washington about I am not naive about politics, but I amendment is included in the con- the need for reform. There was Mat- expected more. I will vote for health ference report. If not, I will fight to get thew Temme of Castle Rock, who could care reform because it is a step in the it passed on its own. I believe so not receive coverage because his wife right direction. But I will not go home strongly in this because everyone here was pregnant, even though she had her and defend the actions of a Washington knows that keeping things the way own health insurance. that is out of touch, a Washington that they are is no longer acceptable. The sad thing is, there is nothing un- is more interested in scoring political When I first started in the Senate, usual about these stories. None of points, more interested in the 278 800,000 Coloradans were without health these people were trying to cheat or health care lobbyists who used to work insurance. That number has grown by game the system. They were trying to

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00025 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32931 gain some peace of mind, some sta- without copayments. Now mammo- legislation I wrote based on the work bility in their lives and, instead, they grams and colonoscopies, which can in Mesa County, home of Grand Junc- wasted weeks of their lives fighting cost between $150 and $200, on average, tion, CO. Currently, one out of every against insurance company bureauc- will be free as well for seniors—half a five Medicare patients who is released racy and mounting bills. million seniors in my home State from the hospital in this country winds We have debated health care reform alone. This means catching diseases up back in the hospital in the same for over a year. Some have been work- earlier, promoting wellness, and saving month they were released but not in ing on these issues for decades. Killing millions of lives. Mesa County. They have reduced the health care reform under the disguise For our Nation’s working families, readmission rates at the hospital to of starting over is not an option. We this bill will also rein in the worst about 2 percent, compared to the na- cannot wait until after the next elec- practices of private insurance compa- tional average of 20 percent. That is 12 tion. We cannot wait until our econ- nies. They will have to commit to cov- million patients who aren’t receiving omy recovers or until we have come ering patients instead of gouging them the care they need. In Mesa County, home from Afghanistan to deal with for excessive profits and overhead. they have lowered readmissions by cre- our broken health care system. Starting in 2011, if an insurance com- ating a transitional model that makes Now standing so close to the finish pany doesn’t give you value for your sure that when patients leave the hos- line, it is completely understandable dollar, they will have to refund you pital, they do so with a coach. That that some Americans doubt whether back the difference. They will not be coach helps them go from the emer- this bill will improve their situation. able to impose arbitrary lifetime limits gency room to their primary care phy- They understand we cannot live with on consumers and punish you just for sician, their mental health provider, the current system. But they are also getting sick or deny you insurance be- making sure they get the care they deeply concerned about our capacity to cause of a preexisting condition. The need over a period of time, making sure make it worse. newest Senate bill does more to con- they don’t forget their prescriptions, The special interests are using tried- tain costs, more to demand account- and making sure they have the guid- and-true tactics that have been em- ability and transparency from insur- ance they need to take responsibility ployed over and over across the decades ance companies, and more to give con- for their own care. I am pleased the to prevent reform: phone calls to scare sumers a better choice. Senate bill compensates and reim- For my home State, in particular, I seniors, direct mail to scare those al- burses hospitals and providers that set am glad the bill addresses other crit- ready covered, television ads to scare up models such as the one in Mesa ical areas. This reform does more for just about everyone else, and oppo- County that actually saves money. small business and small business nents of this reform in this body are On another note, I wish to thank the workers than ever before. Small busi- trying every delay tactic permitted by Presiding Officer and my fellow fresh- ness tax credits will begin next year, the Senate rules. men. Together, we worked hard to in- giving eligible businesses a tax credit Amidst all this, there is still a reason troduce a package of amendments to for 6 years to purchase health insur- to hope. After almost a century of try- further contain costs and make our ance for their employees. We have ex- ing, the Senate is very close to finally system more efficient. As I traveled tended tax credits for small businesses, passing a meaningful health care re- throughout Colorado on the August allowing more than 68,000 small busi- form bill, a piece of legislation that break, I heard from doctors and nurses nesses in Colorado to buy health insur- while not perfect, represents a substan- who told me repeatedly all they wanted ance. tial step forward from business as This bill makes a significant invest- to do was work with patients, while all usual. We have a bill that does three ment in Medicare payments to rural the government was doing was making important things: It saves money, it areas. When I first joined the Senate, them fill out one form after another. saves lives, and it gives families a my first piece of legislation called for a When I came back, I was determined to fighting chance in their relentless deficit-neutral reserve to address the do something to help cut the red tape struggle with health insurance compa- differences in Medicare payments be- and bureaucracy for these people so nies. tween urban and rural areas. This Sen- they could spend more time with their This bill will save money. It reduces ate bill recognizes the geographic dif- patients. That is why, as part of the the deficit by $130 billion over the first ferences between rural and urban areas freshman package, I introduced an 10 years, according to the nonpartisan and makes sure providers in rural Colo- amendment to put an end to multiple Congressional Budget Office, and is rado that provide higher quality at forms, confusing codes, and unneces- projected to reduce the deficit by 10 lower cost receive higher Medicare sary paperwork that burden providers. times that—up to $1.3 trillion—in the payments. If health plans don’t follow the rules, second decade. We will save $1⁄2 trillion This bill also delivers on its promise they will suffer financial penalties. Our by improving the way we deliver serv- to seniors. It doesn’t use a dime of the health care workers deserve better, and ices to our seniors. These savings will Medicare trust fund to pay for reform this amendment gives them back time prevent Medicare from going broke in 7 and does not cut guaranteed benefits. to spend with their patients. years by extending the life of the Medi- That is why, on the first day of the Our freshman package rewards and care trust fund. health care reform debate, I introduced emphasizes efficiency: one form to fill This bill will save lives. It will ex- an amendment that would make sure out, not 10; less red tape; fewer bureau- tend health insurance coverage to 31 seniors will still see their guaranteed crats; a system that makes sense. million Americans who don’t have it benefits, such as hospital stays and Thanks to the leadership of the Pre- today. Over 90 percent of Americans prescription drug coverage, no matter siding Officer, that package was en- will have health insurance coverage, what changes we make in health re- dorsed by the Business Roundtable, the the highest percentage in the history form. It was the most bipartisan piece AFL–CIO, and the Consumers Union— of the United States. For Colorado, of legislation we have had this year, proof that at least off this floor, there that means over 840,000 people who with 100 Senators agreeing health re- are still people from all different don’t have insurance will now have ac- form would not take away guaranteed points of view who are willing to work cess and another 300,000 people who Medicare benefits for seniors. For Colo- together. have insurance in the unstable indi- rado, that means half a million Medi- This bill also makes progress in the vidual market will be able to get af- care beneficiaries will continue to have area of tort reform. It includes lan- fordable coverage through the new their guaranteed benefits protected and guage I worked on with Senators BAU- health insurance exchange. preventive services free of charge CUS, CARPER, and LINCOLN to create a The Senate bill makes preventive through health reform. State grant program for States to de- services, such as breast cancer and I am very pleased Majority Leader velop, implement, and evaluate alter- colorectal cancer screening, available REID included a version of a piece of natives to tort litigation for medical

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00026 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32932 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 malpractice claims. The purpose of ington still doesn’t get it. I know we they are going to be paying $24,000 to these grants is to limit litigation while can do better, and despite so much evi- $36,000 a year for their health insur- preserving access to courts for patients dence to the contrary, I believe we will. ance. Just look at these numbers. Look and promoting strategies to reduce I believe we will because, in the end, at where we are. In 1999, a single person medical errors. the national creed that each genera- was paying about $2,100 for their health I know many in this Chamber take tion of Americans has fought for and care. They were paying for a family, issue with one particular part of this fulfilled—the idea expressed in our $5,790 for their health care. Where are bill or another. I have my own issues Constitution that our responsibility we now? Last year, in 2008, a single per- with the bill. I am one of many who lies not just with ourselves but to our son was paying $4,700 for their health have expressed their strong preference posterity—is so much more powerful care and then a family was paying for a public option. But I urge my col- than the trivial politics that animate $12,680. Especially during this difficult leagues to consider how much good this so many of the charges and counter- economic time when wages haven’t bill can do for the American people— charges that ricochet around this been going up, people have been losing those with skyrocketing health care building. their jobs, cutting back on their hours, costs, small businesses forced with the It is for this reason I urge my col- and look what their health care costs impossible choice of helping workers leagues to come together and support have been. It has been a higher and keep their coverage or even just main- this meaningful improvement in our higher percentage of their family budg- taining their business. To have the health care system. et, a higher and higher percentage. nonpartisan experts at the Congres- I yield the floor. At the same time, health care ex- sional Budget Office validate that in The PRESIDING OFFICER. The Sen- penditures are going up and up and up. the second decade we will have cut ator from Minnesota. In 1995, we were spending something health care costs by up to $1.3 trillion Ms. KLOBUCHAR. I ask unanimous like $12 billion and now it is way up to and that we will reduce the rise in consent to yield myself 10 minutes. $2.5 trillion. This is the kind of money costs of Medicare from 8 percent in the The PRESIDING OFFICER. The Sen- we are talking about when we look at next two decades to 6 percent in the ator is recognized. why we have to do something to bend next two decades, while covering 31 Ms. KLOBUCHAR. Mr. President, the cost curve. When people at home million insured Americans, is truly late last night, as my colleagues are hear this term ‘‘cost curve’’ and they groundbreaking. aware, the Senate took the important don’t know what it means—well, this is We know what more time elapsing step to move forward on health care re- exactly what it is: The cost curve has without fixing this system means for form. After all the work, the debate been going up and up and up for health Colorado’s working families and small that has gone on for this entire year, care in America. businesses. It means more double-digit we owe the American people a vote on So $1 out of every $6 spent in our premium increases, less time to fix this issue. We can’t afford to ignore economy is on health care. Over 20 per- Medicare before it goes bankrupt in this situation anymore. cent of our economy, by 2018, we be- 2017, and more names added to the rolls I know some of my colleagues on the lieve, will be spent on health care. of the uninsured. It means another big other side of the aisle have been talk- American families can no longer afford win for the special interests, more peo- ing about a lack of debate. I think any- it. ple denied coverage for preexisting con- one who has turned on C–SPAN for the Who has been taking it the worst? ditions, and more small business em- last few months will tell you there has Small businesses. They are paying 20 ployers will have to make impossible been a lot of debate—not only that, a percent more than large businesses for decisions about covering their workers number of Republican amendments their health care. In a recent survey, or keeping their doors open. were actually included in the original nearly three-quarters of small busi- So let’s reject business as usual. bill, the HELP Committee bill. When it nesses that did not offer benefits cited Let’s look at the promise of this Sen- came out, I believe it was something high premiums as the reason. ate bill as a whole. Let’s put the petti- like 130 amendments that were in- These are little companies such as ness, scare tactics, and obstruction cluded that came from their side—and Granite Gear up in northern Minnesota aside. Reform is what is needed to con- the Finance Committee as well. and Two Harbors. I went up there and trol costs, give people more choice, and I remember the first bipartisan meet- visited them. They are a thriving little provide support for our small busi- ing we had on health care reform was company. They now have 15 employees. nesses. This package will reduce our something called Ready to Launch that They are making backpacks for our deficit, and it does so by reforming the the Finance Committee put together. I Nation’s soldiers because they make way we provide health care. remember Senator WHITEHOUSE and I such high-quality backpacks. Do you We have much to do. Even before we were there. It was literally a year and know what the man who started that were in the worst recession since the a half ago. So many of the ideas that company told me? That if he had Great Depression, during the last pe- are now incorporated in this bill that known how much his health care would riod of economic recovery, working Senator BENNET from Colorado just so cost with his family of four—he did not families’ incomes in this country actu- eloquently went through are in this have kids when he started the busi- ally declined, the first time in the his- bill, so many of the bipartisan ideas to ness—he would not have started it tory of the United States, the first kick off cost reform, to start rewarding today. He is paying $24,000 in Two Har- time our economy grew and left the high-quality care, to start bringing bors, MN, for a family of four. middle class behind. At the same time, down those costs in a way that gives us This is what it really means when in my State of Colorado and in all the high-quality care. you look at the numbers. Inflation usu- States across the country, the cost of We all know that rising costs are not ally raises the cost of most goods and health insurance rose by 97 percent and sustainable. If we don’t act, these costs services between 2 and 3 percent a year. the cost of higher education in my are going to continue to skyrocket. What have health care premiums been State went up by 50 percent. Finally, So what was the vote about last doing? Health care premiums have been because of the short-term politics prac- night? The vote last night was to say going up close to 8 percent a year, and ticed around here, we now have an an- we are not going to put our heads in that is an increase Americans simply nual deficit and long-term debt that is the sand anymore. We are not going to cannot afford. cheating our children and constraining keep letting these costs go up. What does this bill do? I was listen- our choices. Ten years ago, the average family ing to some of the commentary and We still have a lot to do to live up to was paying $6,000 a year for their taking part in it myself over the week- the legacy that our parents and grand- health insurance. Now they are paying end. There seems to have been a lot of parents left us. It has taken me less $12,000 a year. Well, 10 years from now, talk about these delayed benefits. Why than a year to understand that Wash- if we don’t do anything about this, don’t we talk about the benefits that

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00027 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32933 are taking place right when the Presi- What Dartmouth found is if all the made a mistake or they gave you an in- dent signs this bill, within the first hospitals in the country followed the fection. Let’s provide incentives—that year of this bill? same protocol, we would save, for this is what this bill does—so that we re- The first thing is, if your kid loses subset alone, $50 billion every 5 years duce those hospital readmissions, make their coverage because something goes in taxpayer money, giving patients life better for the patient and at the wrong—if they get diabetes or if they that Mayo health care, giving them same time reduce taxpayer money. have some childhood disease—guess high-quality health care. It is counter- That is what this bill is about. what. They are going to be able to get intuitive to people. If you go to a hotel Right now, fraud is $60 billion. I don’t health care. There is no longer a ban and you pay the most, you are going to think anyone would believe this. A sen- on preexisting conditions immediately, get the best room with the best view. ior who just depends on Medicare, and then in later years that applies for That has not been the same in Amer- right—we have to tell our seniors adults as well but immediately for ican health care. In fact, there is an in- today that $60 billion a year is wasted kids. verse relationship. on Medicare fraud, going to con men, Immediately, by 2011, within the first I see my friend from Ohio. Ohio has going to people who set up storefronts year of the bill, our seniors are going the Cleveland Clinic, and there is and they get fake checks and they are to be covered in that doughnut hole for Geisinger. Those places that offer high- not even real. That is where the money their prescription drugs. So many of quality care also tend to have some of is going right now—down the tube, si- them for so long—I know my own the lowest costs. phoned off by fraudsters. What this bill mother would complain about this Those are the incentives we are put- does is give the tools to improve that doughnut hole where they fall off a ting in this bill—incentives for ac- situation so that will not happen any- cliff and are not able to pay for their countable care organizations, incen- more. drugs because they do not have enough tives for that integrated care I talked That is what we are doing with this money. That will be covered. about instead of people running around bill. It is about reducing costs, it is A number of the small business tax with x rays to 20 specialists, getting about raising quality, and it is about credits take effect by 2011. These are charged every single time, but then one saving Medicare so it does not go in the real benefits for the people of this specialist does not know what the red by 2017, giving it 10 more years and country—real benefits. other specialist is doing. They don’t beyond because of the delivery system The thing I care most about in this know what kind of drugs you are aller- changes. bill which Senator BENNET discussed is gic to when you go in for surgery. This I am proud to support this bill. We this idea of getting our money’s worth is because there is no communication. continue to work for reform. As you for our health care dollars. What does This bill promotes that integrated care know, this is not just an end, this is a this bill do? This new bill—we have where you put the patient in the driv- beginning. There will be more work to taken a lot of the good from the origi- er’s seat so they have their pick of a do in the future, but we cannot put our nal bill and made things even better: doctor. That is what we want—bun- heads in the sand. We have to vote on $132 billion off the deficit in the first 10 dling of payment so you start reward- this bill. We have to get this done. years and in the next 10 years, $1.3 tril- ing outcomes instead of the number of I yield the floor. lion off the deficit. That was the most tests and procedures. The PRESIDING OFFICER. The Sen- important thing to people in my State My favorite example of this came out ator from Ohio. when I went around. They said: We of the Geisinger Clinic in Pennsyl- Mr. BROWN. Mr. President, it has want to get rid of these preexisting vania, where they said: We are not that been said that a cynic knows the price conditions, we want to make things happy with how we are treating diabe- of everything and the value of nothing. better so we have better health care, tes patients. So instead of having ev- I spent, as we all have, as the Senator but we want to make sure we do some- eryone wait to see an endocrinologist, from Minnesota has, as the Presiding thing about the deficit, start doing a doctor, we are going to have some of Officer has, the last 4 weeks listening something about costs. the routine cases see nurses, and the to my colleagues come to the Senate As you know, Mr. President, Min- nurses will report to the doctors, and floor to describe health reform legisla- nesota is a mecca for health care. We the patients will be happier because tion that bears no resemblance to what have one of the high-quality, cost-effi- they will be able to see a nurse more is actually before us. They take lib- cient, low-cost States in the country. often. The most difficult cases will be erties with the cost of the bill. They In fact, when we look at some of the treated by endocrinologists. seem to have no concept of the value of numbers, one of my favorite ones—and They did that for about a year and health care to a family who has it and maybe this will be the last time I will looked to see what the results were. to a family who does not have it. I say this before the end of the year—is Guess what. The patients were much guess they believe it is not important Mayo Clinic. They did a study out of happier because they were able to com- for us to get this done, it is not impor- Dartmouth, and they looked at what municate one-on-one with the nurse. tant for other Americans to have af- Mayo did with chronically ill patients. The doctors were able to handle the fordable health insurance. What they found was this: If other hos- most difficult cases and monitor the My colleagues are not at risk of los- pitals in the country simply use the other cases. They saved $200 a month ing their coverage. They can afford the same high-quality care Mayo uses— per patient with this kind of system. health care they and their families bring the family in, talk to them about Higher quality care and better patient need. So what is it to them if another what the care should be for the pa- outcomes. 14,000 people lose their insurance every tient—they talk to the patient and What does our system do when they day? Mr. President, 390 people every then figure out what is the best course. see this kind of smart, cost-effective single day in my State lose their insur- They work as a team, like a quarter- result for the doctors and for the sys- ance. What is it to them if people with back with a team working with that tem and for the taxpayers? They actu- preexisting conditions cannot get cov- quarterback. They do not have 20 spe- ally are told: You get punished for this erage, if women are overcharged for in- cialists falling all over each other; under our system. You are going to get surance, if the self-employed cannot af- they work as a team. What this study a lot less money if you do something ford the outrageous premiums they are showed was this kind of health care for like this. That is what I am talking charged, if too often American small that subset of chronically ill patients about. businesses pay more for health cov- in the last 4 years of their lives, the On hospital readmissions, we could erage than they earn in profits? What quality ratings were sky high for the save $18 billion a year. If you go in the is it to them? Mayo Clinic. The families felt good hospital and you are treated, you want I have listened as Republican Sen- about how their loved ones were treat- to go home. You don’t want to go back ators have come to the Senate floor ed. into the hospital because someone day after day to tell tales about health

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00028 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32934 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 care reform and try to manipulate pub- am guessing they are probably in their form that bars insurance companies from de- lic opinion by any means possible. I late fifties, early sixties. They are not nying coverage or charging higher premiums hear them mostly stalling: Slow down, eligible for Medicare. on the basis of preexisting conditions. Health not yet. They have done it since the So many people say to me through reform is the right solution for the people of Ohio. Gang of 6 in the Finance Committee these letters and through my meetings met in June. No, actually they had and discussions and when I am trav- The PRESIDING OFFICER. The Sen- begun to stall even before that when eling around my State: I am 63. I only ator’s time has expired. the Finance Committee and the HELP have 2 years before Medicare because I Mr. BROWN. I yield the floor. Committee began their deliberations, trust Medicare. It is stable, predict- The PRESIDING OFFICER. The Sen- informal deliberations. able. It will be there for me, and it will ator from Wyoming is recognized. What they forget or what they do not help. Mr. BARRASSO. Mr. President, I just want to think about, perhaps, is that Instead, Republicans in this body, all heard my colleague, the Senator from every day they stall, 390 people from 40 of whom even voted against the bill Ohio, say: I wish some of my colleagues Galion to Gallipolis, from Buckeye last night—40 said: Stop. Don’t even on the other side of the aisle would un- Lake to Avon Lake, from Ashtabula to move forward on this bill. Do any of derstand families who don’t have insur- Cincinnati, 390 people in my State lose those 40 really understand people such ance. their insurance every day. Every day, as Marie from Hancock County? Do I practiced medicine for 25 years, we see 14,000 Americans lose their in- any of them understand? Do any of taking care of families in the State of surance, and 1,000 Americans die every them understand that 390 people are Wyoming. During that time, I took week because they do not have insur- losing their insurance every day in just care of all patients, regardless of their ance. One thousand Americans die one State? Do any of them understand ability to pay. I will tell you, I believe, every week because they do not have that 1,000 people a week are dying in as a physician who practiced medicine insurance, and on the other side of the this country because they do not have for 25 years—and as someone whom the aisle they say: Slow down. What is the insurance? Do any of them understand, Obama administration has decided to rush? Why do we have to move into any of the Members of Congress, the completely ignore, as he did the other this? House of Representatives or the Sen- Senator of this Chamber who is a phy- They forget or maybe they just do ators, the 40 Senators who said no and sician—that I know specifically and not want to hear that a woman with stall and stall, saying: Not yet; can’t personally about what happens to fami- breast cancer is 40 percent more likely do this yet; have to slow it down. Do lies who lose their insurance. My col- to die if she is uninsured than if she any of them understand that a woman league and I know specifically what has insurance. Women with breast can- with breast cancer is 40 percent more happens to families who are on Med- cer are 40 percent more likely to die if likely to die if she does not have insur- icaid, a health care program which my uninsured than if they have insurance. ance than if she does? colleague who is now leaving the Yet they continue to say: Slow down. Charles from Cuyahoga County, the Chamber after asking if anyone in this I wish my friends on the other side of Cleveland area, writes me: body understands people without insur- the aisle would actually meet some of The hands-off-health-care people claim ance but not staying to hear the dis- these people who do not have insur- that many Americans are very satisfied with their own health insurance. I am one of cussion for the next hour—making ance. Let me put a human face on this, those. I have Medicare. But I don’t believe statements and then leaving—I under- if I can. Let me share three letters their implication that health care reform is stand those families. I understand the from Ohioans. I have come to the floor not needed. I think if you were to really ask families on Medicare, I understand the since July day after day reading letters those lucky people who were somewhat satis- families on Medicaid, I understand the from people directly affected by this fied with their plan—a great majority would families without insurance, I under- health insurance situation, if you will. say they support reform that would benefit stand the families worried about losing In most cases, these are people who everyone. their insurance, I understand about the were happy with their health insurance Charles understands. He is on Medi- families worried about disease. a year ago, and something happened in care. He understands the stability and My colleague from Ohio said: Do peo- their lives—they got laid off and lost predictability of the Medicare system. ple understand women with breast can- I might add parenthetically that my their insurance; had a child with a pre- cer? Well, my wife is a— Republican friends, all 40 of whom last existing condition for whom they could Mr. BROWN. Will the Senator from night said: Stop, slow down, stop, slow not get insurance; maybe they got sick Wyoming yield? down, all 40 of them understand that and the cost of their health care was so Mr. BARRASSO. Regular order, Mr. their party overwhelmingly opposed high that the insurance industry cut President. the creation of Medicare. When they them off, simply eliminated their cov- Mr. BROWN. I just wished to let the had a chance, they tried to cut it and erage. Let me read a couple of these. Member know I am still in the Senate. privatize it in the nineties. Then when Marie from Hancock County, OH: Mr. BARRASSO. My wife was a President Bush was sworn in, with Re- My husband and I both have preexisting publican leadership in the House and breast cancer survivor, and her breast conditions and are stuck paying $1,300 a cancer was discovered in her forties by month for health insurance. He has been out Senate, they moved forward on their giveaway to the drug companies and a screening mammogram. It was that of work for 2 years and we are living off the screening mammogram that saved her money that we got when we sold our house. insurance companies in their attempts We are afraid to go without insurance. We to privatize Medicare. Now they say life because the cancer had already are in a fix and in our late middle ages and they are all for Medicare. spread. It had already spread to a find ourselves watching our retirement sav- Understand, Charles knows what this lymph node. She had three operations, ings go down the drain. Please fight for us bill is going to do. It is going to two bouts of full chemotherapy, radi- and others like us. strengthen Medicare. It is going to ation—35 treatments and all—all—be- Think about that. Does anyone in lengthen the lifespan of Medicare. It is cause of the screening mammogram this Chamber, does anyone who comes going to give free physicals, once-a- that saved her life. Yet because of this to work as a Senator or down the hall year checkups, colonoscopies, and bill that was brought to the Senate as a Congressman—can any of us really mammograms for people on Medicare, floor—with the government knowing understand what this couple is all and it is going to close the doughnut better than the rest of America, know- about, this couple from rural, hole so fewer people will have to pay so ing what health care ought to be given smalltown Ohio paying $1,300 a month? much out of pocket. and shouldn’t be given—all of a sudden How are they paying for their insur- Last letter. Raymond from Delaware what we see is the government knows ance? They sold their house so they County: best, people don’t know—her life would could pay for their health insurance. My wife and I had to drop our coverage be- have been lost because she is one of They are in their late middle ages. I cause it cost us $30,000. The country needs re- those 1,900.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00029 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.000 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32935 So I understand, having practiced practice of medicine and taking care of of a certain age we depend upon it for medicine, having lived that life as a families in this country—were com- our medical care. For many Americans, physician—taken care of people with- pletely excluded—completely ex- it is very important. It was established out health insurance and on Medicaid cluded—even though we offered to go with broad bipartisan support in the and Medicare and those worrying about to the White House and read the bill 1960s. losing their insurance when they lose with the President. What are the proposals that have to their job—the implications. Yet I took So what do we have? What is the ver- do with Medicare? Well, basically half care of all of them, as did all my part- dict of the American people on the vote this health care bill is paid for by re- ners. We dealt with all these people, that was taken in the dark of night—at ductions in the growth of Federal trying to help each and every one of 1 a.m. in the morning—a Monday spending for Medicare. Those are Medi- them, regardless of their ability to pay. morning vote, taken at 1 a.m. so the care cuts. Who says they are? Well, the It is why we need health reform in this American people, hopefully, according President of the United States, for one, country that actually works on avail- to the Democrats, would be asleep and says we will have no deficit from this ability of care, affordability of care, not see what they were doing to the bill. So the way we are going to do access to care, and quality care. This American people? The verdict is the that, for this bill, which the Congres- bill that I voted against last night American people are overwhelmingly sional Budget Office figures show us doesn’t address the needs of the coun- opposed—opposed—to the bill the Sen- will cost $2.5 trillion over 10 years try. It fails time and time again. ate last night voted 60 to 40 on cloture when fully implemented, is basically The President made a number of and decided to move ahead on. paid for one-half by Medicare cuts and promises—a number of promises—to The deals in the bill are absolutely one-half by new taxes. Give the Demo- the people of this country. He said peo- astonishing: $100 million for a hospital crats credit for that, that helps to ple would see their insurance premiums in a State we still can’t identify and no avoid a large part of the deficit. The drop by $2,500. Instead, the budget offi- one is claiming, a payoff to one State, rest is done by sending a huge bill to cers say: Oh, no, it is going to go up a payoff to another State, and then the States to help pay for another big gov- $2,100 for a family. Has the President cuts in Medicare for our seniors who ernment program called Medicaid, but not read the bill, not read the re- depend on Medicare, a program that is I will leave that to the side for a mo- sponses that have come from the Con- going to go broke in the year 2017—not ment. gressional Budget Office? Does he not to save Medicare. Instead of saving The Medicare cuts which are reduc- see the difference there of $4,600 per Medicare, to start a whole new govern- tions in the spending for Medicare, are family? ment program. $466 billion over the first 10 years and The President said this wouldn’t add I see my colleague from the State of over a fully implemented 10 years it is a dime to the deficit. Well, it is going Tennessee is standing, and he has about $1 trillion in Medicare cuts. That to add a lot of dimes to the deficit. worked closely with people on Medi- is money coming out of the Medicare This is going to add $1 trillion to the care in his home State. He is familiar Program and going somewhere. Where deficit. He said: Oh no, will not at all. with that and with Medicaid and he does it go? Well, it goes to start a new Yet they didn’t do the doctor fix—the knows how difficult it is for patients to program. Medicare doctor fix. Now the Speaker get to see a doctor. With the cuts in What is wrong with that? Well, one of the House says: Oh, we will handle Medicare, it is going to make it harder thing wrong with it is the trustees of that in January or February for $250 for those hospitals to stay alive and Medicare say that there is already billion, since they are not going to pay open in your community, and for pa- more money coming out of Medicare for it here. tients to get the kind of care they than is being paid in, and by the year The President said: Taxes will not go need. 2015 or 2017 it will be insolvent. That up on anybody making under $250,000 So I would ask my friend from Ten- means going broke. These aren’t Re- for a family. There are a dozen taxes in nessee: Are there concerns you have publican trustees or Democratic trust- the bill that will be passed on to the about the cuts to Medicare and how ees, these are the men and women American people. Now any teenager they are going to impact on the care of whose job it is to report to the Nation who goes to a tanning salon is going to people in your home State? on the condition of this program that get taxed 10 percent. I don’t think any Mr. ALEXANDER. I thank the Sen- takes care of 40 million people and of those people are making over ator from Wyoming and appreciate his their medical care. $250,000 apiece. leadership on this bill. It is of tremen- Already we see that the Medicare The President said: People will not dous value to have within our body two Program is under some stress. The doc- lose their coverage. Oh, they are going practicing medical doctors to help us tors, for example, who serve Medicare to lose their coverage. Many will lose interpret the effect of this bill, which are only paid about 83 or 84 percent as the coverage they have, coverage they affects all 300 million Americans so much as doctors who serve patients like, because they have cut 11 million dramatically. with private health care. As a result of people on Medicare Advantage—a pro- We find, when we discuss this bill that, we have to come along year after gram people like, a program my pa- with our colleagues on the other side of year and appropriate more money to tients like. People whom I have taken the aisle, we sometimes become exas- reimburse doctors who serve Medicare care of like it because there is actually perated with one another because it patients. If we do not do that, they will an advantage to the program. It is a seems like they are talking about one not be serving Medicare patients, and program that deals specifically with set of facts and we are talking about Medicare will become similar to Med- preventive care. It is coordinated care. another set of facts. So what I would icaid, the program for low-income That is what happens with Medicare like to do is take a moment and talk Americans, where about 50 percent of Advantage. The President doesn’t like. about Medicare. doctors will not take a new Medicaid They will lose their coverage. If anyone is watching our debate, you patient. It is akin to telling somebody: Of course, the President said we hear the Democrats talk about three I am going to give you a ticket to a bus wouldn’t see any cuts to Medicare. Yet things: We are saving Medicare, we are line where the bus only runs about half the bill says $500 billion of cuts to extending its length, and you hear Re- the time. Medicare for the seniors who depend publicans say they are cutting Medi- So what the Democrats are saying to upon Medicare. care. So who is right? us is that by taking $1 trillion out of The President said we would have an Well, let me tell you why we talk Medicare over 10 years when fully im- open, honest debate. He said C–SPAN about Medicare cuts. Medicare, of plemented, and there is no dispute would be there covering the debates. course, is a government program which about that amount of money, and Those of us with the most experience— 40 million seniors depend on. We all spending it to pay for this new program the two physicians, with 50 years in the pay into it, and then when we get to be that is somehow good for Medicare and

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Mr. President, I would say colleague is correct that once the ma- agencies and $7 billion from hospices, to our colleague, as a general rule that jority leader made the decision that that somehow that is good for seniors. is correct. The majority leader has two this has to be done by Christmas, then Perhaps it could be, if all that money great powers that no one else in the the time is pretty well set by the Sen- were put back into Medicare; if the Senate has. One is the right of first ate rules, absent a unanimous consent money were taken from grandma and recognition by the Presiding Officer by the body that would either extend spent on grandma. But no, this money and the other is the power to set the the time or shorten that amount of is taken out and spent on a new pro- schedule. That power is limited by Sen- time. gram. The Director of the Congres- ate rules, and it can be altered by I would like to make another point, sional Budget Office—not a Republican, unanimous consent. I can go on and ex- off that subject if I could, but if my not a Democrat, the nonpartisan Direc- plain a little bit to folks who are won- colleague has another question in that tor said, for the 11 million on Medicare dering why we would be in this predica- regard I would be happy to try to re- Advantage that one-half of their bene- ment of voting on Christmas Eve based spond it. fits will be diminished. That is what he upon the majority leader’s decision. If Mr. ALEXANDER. No, I thank the said about these cuts. I can just proceed, I will do that. Senator. I yield the floor. Even when it is all said and done, we All of these rather odd times for de- Mr. KYL. I talked to the Senator from Wyoming. Of course, Arizona is a completely leave out the $1⁄4 trillion bates, 1 o’clock in the morning, 7:20 that we need to appropriate to pay the a.m. in the morning, and so on, are as State that has a lot of Medicare pa- physicians to serve Medicare patients. a result of the majority leader’s deci- tients. Our State is hurt as much as Because if we don’t, their payments are sion to make sure that this bill is com- any by the cuts to Medicare and par- going to be cut by 21 percent next year pleted by Christmas. That is the pre- ticularly the Medicare Advantage cuts. We do not have the benefit that was ex- and fewer of them will see Medicare pa- cipitating cause for everything else tended to residents of other States, pri- tients. We have already heard the that follows because once he says the marily the State of Florida, by a spe- Mayo Clinic, for example, is beginning bill has to be completed by Christmas, cial provision that was inserted into to restrict some patients on Medicare then he has to, in effect, count back- the bill. As a result, our constituents because they lost $840 million serving wards on how long it takes to do the are going to suffer more than those of Medicare patients last year. various things the Senate rules say we I have taken a few moments to talk some other States. have to do. But the more we read this bill—and about Medicare. That is just one thing If there are three cloture motions one of the reasons Republicans have wrong with this bill. But when you filed—which is what the majority lead- not been willing to truncate this de- hear the other side say they are help- er did; he filed three cloture motions bate is that the more we read it the ing Medicare, and if you listen to what simultaneously—under Senate rules more we find in it that is troublesome. I said about how can you take $1 tril- certain timeframes then attach. We found yesterday that the Congres- lion out of the Medicare Program— You have to take the vote with 1 day sional Budget Office—actually the Con- which is going broke—when it is fully intervening between the filing of the gressional Budget Office brought to our implemented over 10 years and claim cloture motion and the vote. If cloture attention the fact that they had made you are helping Medicare by starting a is invoked, then 30 hours for debate is a little mistake. I think it was a quar- new program, I don’t think that is pos- permitted after which there can be ad- ter of 1 percent in one of their calcula- sible. That is the source of the great ditional action by the Senate. So when tions. That quarter of 1 percent concern on our side of the aisle about the majority leader takes all that into amounted to $600 billion. So a small this bill on that one issue. account, he finds that he has to vote at error by the Congressional Budget Of- I see the assistant Republican leader, 1 a.m. in the morning, 7:20 a.m, and so fice can make a huge difference to the the whip. I have heard a number of peo- on. people of America. That is $600 billion. ple say, and I will just propound this He could change that, of course. He We also saw there were special provi- question and then I will yield the floor, could change that by saying we do not sions in the bill for residents of one if I may, to the Senator from Arizona. actually have to have the whole thing particular State, and that has gotten But I have heard them say: Why are completed by Christmas. That is strict- quite a bit of attention lately. There Republicans keeping everybody in here ly an arbitrary date he set. has also been a dental/vision clinic in a this week? We want to go home and see There have been some who said: Why State that has benefited. I am still not our families. don’t we have a unanimous consent re- sure we have figured out exactly what We all want to see our families. But quest to not put us through all of this that State is, but I understand one of there is a reason this bill was suddenly and try to complete the debate a cou- the Senators from Connecticut has presented to us in the middle of the ple of days earlier? taken credit for it. I don’t know if that greatest snowstorm in the history of Republicans have said: Now wait a is true. It is hearsay. If that is incor- Washington in the month of December, minute. You are telling us on the one rect, I can be corrected. But the more and we were asked to start voting on it hand that the majority leader is saying we see about it, the more we realize in the middle of the night on the same we have to have this completed by that support for it was garnered, not on day, and to finish the work by Christ- Christmas, but since that is kind of the merits but on the basis of special mas. If I am not mistaken, and this is tough on all of us, now you are saying favors done to certain Members. my question to the distinguished as- let’s move that up a couple of days. My staff has indicated there is yet sistant Republican leader who has been Republicans are saying: We have had another one of these in the bill, and it here a number of years, who is in the barely enough time to consider this bill has to do with so-called specialty hos- leadership and whose job is to help as it is. We are not going to agree to pitals or, as they are referred to in the manage the floor: Is it not entirely the move it up any more than that. We legislation, physician self-referral hos- prerogative of the majority leader of don’t like voting on Christmas Eve any pitals, that have physician ownership. the Senate to schedule what comes up more than you do, but the answer to it Just a little bit of background on on the floor? Is that not his job? Isn’t is not making the time even shorter this. The Hospital Association that is it true that if Senator REID wanted to but, rather, taking our time and doing primarily representative of the com- say let’s take this bill down, let’s go it right. As the Senator from Maine munity hospitals has been pleading for

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I have tried to help them, for bled by Mr. Reid would provide exemptions able, or at least this Senate ought to to a small number of such hospitals, includ- be able to debate an amendment about example, for reimbursement in the care ing one in Nebraska. provided to illegal immigrants, and we allowing Medicare patients the right to He goes on to describe this and then were successful in that. privately contract for medical services But one area I departed from that is quotes Molly Sandvig, executive direc- with the physician of their choice? when they concluded the best way to tor of Physician Hospitals of America, Wouldn’t that seem fair? help themselves was to hurt their com- which represents doctor-owned hos- Mr. ALEXANDER. Mr. President, I petition. At that point I said no. Their pitals, who said the change would ben- agree with the Senator from Wyoming. competition is the physician-owned, efit Bellevue Medical Center, scheduled I think it is important for the Amer- self-referral hospitals. These are gen- to open next year in Bellevue, NE. ican people to know, the 400-page erally specialty hospitals in a commu- Under the proposal Ms. Sandvig said, ‘‘doc- amendment that was added to the un- nity that provide very good care. While tor-owners can continue to refer Medicare derlying bill over the weekend is being patients to the hospital’’ in eastern Ne- presented to us in way that will not they do in one sense provide competi- braska. tion to the community hospitals, they allow the bill to be amended. So some- ‘‘Senator Nelson has always been a friend thing that affects one-sixth of the are all in the same boat in terms of the to our industry,’’ she said. ‘‘But doctor- kind of reimbursement that Congress owned hospitals in other states were not so economy, which we have had a day and provides. What I have said is you fortunate. They would not meet the August a half to read, which is part of an over- all bill that will raise taxes, cut Medi- should not solve your problem by hurt- 1 deadline.’’ care, and send big bills to States could ing your competition but having Con- I would like to help all the physician- be improved with amendments but can- gress solve the problems that affect owned hospitals. I agree that all of not be amended under the current pro- you both. I have been willing to try to them should have the same kind of sup- port that was gained by the Senator cedure. help on that. Mr. BARRASSO. Another amend- In this legislation what they have from Nebraska for three specific hos- ment—I see my colleague from South pitals in Nebraska. I understand, by done, they struck a deal with the Hos- Dakota is here—is an amendment I of- the way, that three or four hospitals in pital Association to stop the competi- fered on the floor of the Senate yester- Arizona would also benefit from that. I tors, the physician self-referred hos- day to protect individuals from sky- think that is a great thing. pitals, from building any more hos- rocketing insurance premiums. You But instead of just benefiting the pitals. You have to be under construc- may recall the President of the United hospitals in a few States by moving the tion by a certain date under the bill— States said premiums—families in Wy- date back to where you catch the ones it is February 10, 2010. You have to oming and other States, families across have a provider agreement in oper- in the State of Nebraska, we ought to the country—health insurance pre- ation—that is the technical term—or eliminate this requirement altogether miums would go down $2,500 per family. else you cannot go any further with because what you are going to do is Yet what I read and studied, and as I your new physician self-referred hos- prevent more competition from very look at this, it says to me it looks like pital. That is going to hurt a lot of high-quality hospitals in communities premiums will go up instead of going communities. It turns out that some of that can provide a real service to con- down. Instead of going down $2,500, the communities hurt were in a par- stituents in all of our States, not just they will go up $2,100. I think for 90 ticular State, the State of Nebraska. one State. percent of the families in this country, Again, I have an affinity for Ne- It is just one more example, I say to their insurance premiums will either braska because I was born there, and I my friend from Tennessee, that the stay the same or go up more because know a lot of people there. The Senator more we read the bill and learn what is the bill is passed than if we did noth- from Nebraska, Mr. JOHANNS, a little in it, the more we find that the 60 votes ing. bit earlier today said he didn’t think for it were obtained less by persuasion I ask my friend from South Dakota— the special deals that were created for and on the merits of the bill than by I know he has been bringing forth in- the State of Nebraska were appreciated special provisions that were inserted to formation; I know he put a chart to- by Nebraskans who stand more on prin- assist folks in particular States. gether on it—would there not be some ciple and have the view that if some- As I said, I think if something is good value in allowing the Senate to discuss thing is bad for Nebraskans and it is for one State, it ought to be good for an amendment because this amend- bad for the folks in other States, there- all States. If it is not good for one ment basically said let the State insur- fore it ought to be solved for all of the State, it ought not be a requirement on ance commissioners—because every States, not just for the State of Ne- the other States as well. State has an insurance commissioner— braska. Mr. BARRASSO. Mr. President, what let the State insurance commissioner It turns out that is the case with this you are hearing is what we are noticing take a look at what happens to insur- particular provision on page 332 of the as Republicans take a look at the bill. ance premiums in their State. If the in- Reid so-called managers’ amendment, I saw the majority whip come onto the surance commissioner finds that the which would extend the date on which Senate floor a few minutes ago. Yester- premiums have gone up faster than the a hospital may have physician invest- day he was on the floor and said the Consumer Price Index, then in that ment and a provider agreement in Republicans have not offered amend- State where those premiums have gone place for the purpose of being grand- ments to this bill, so I brought four up faster than the Consumer Price fathered. That date was extended until amendments yesterday. The chairman Index, all of these laws and regulations August 1, 2010. of the Finance Committee objected. and rules would no longer apply. The It turns out that helps, at least ac- One had to do with letting people on mandates, the rating rules, the benefit cording to staff, at least three hos- Medicare keep their own doctors or mandate, all of those included in the pitals in the State of Nebraska—one in choose who they want to go to see for Reid bill would not apply. Omaha, one in Kearney, and one in a doctor. The purpose of this what was Wouldn’t that make sense, I ask my Bellevue. In fact, I will just quote called ‘‘Medicare Patient Freedom to colleague from South Dakota? What is briefly from an article that Robert Contract’’ is it ‘‘allows Medicare pa- the Senator’s understanding of this and Pear of the New York Times did on tients the right to privately contract should not we be allowed to at least this. for medical services with the physician discuss and debate that as a Senate The Senate health bill, would impose of their choice.’’ when we have been promised as citizens tough restrictions like the one passed by the I ask my friend from Tennessee, who of this country that premiums would House last month, would impose tough new has just spoken about Medicare, go down?

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(Mrs. HAGAN assumed the Chair.) 70 new government programs. This is a miums, if we are driving up the overall Mr. THUNE. Madam President, the massive overhaul of health care deliv- cost of health care as a percentage of Senator from Wyoming is correct. Of ery. our economy, why would we be jam- course, we would like to offer amend- What it ought to be about is driving ming this thing through before the ments. I know the Senator from Wyo- down the cost of health care for people. Christmas holiday, these 2,700 pages, ming has deep experience in this field, In fact, we have heard a lot of discus- spending $2.5 trillion of taxpayer being a practicing physician, someone sion from the other side about how this money, raising taxes on small busi- who brings great knowledge and back- drives down the cost of health care. nesses, which obviously have weighed ground to the debate and obviously has This bends the cost curve down. They in on this, and the National Federation great insight about how this 2,100-page can say that, but the experts we rely of Independent Business, which rep- bill could be improved upon. What we on, the referees or the umpires, say resents a lot of small businesses around have here is the 2,100 pages that we otherwise. In fact, what the CBO has the country, has said, if enacted, this started with, and this represents one- said is that the cost curve would be bill would cost us 1.6 million jobs be- sixth of our entire economy. We are bent up by this bill. The blue line on cause of all the new taxes it imposes— talking about reordering one-sixth of this chart represents the increasing you are raising taxes, when fully im- the entire economy. Saturday we re- health care costs year over year if we plemented, by about $1 trillion, cutting ceived an amendment, a 400-page do nothing. The blue line represents Medicare by about $1 trillion. After all amendment which nobody up until Sat- what we would be looking at if we con- that, what do you have? You have the urday had seen. In fact, many of the tinue on the current course which ev- same or worse insurance premiums for Democrats hadn’t seen it either, in- erybody here acknowledges is unac- 90 percent of Americans. I argue that is cluding members of the Democratic ceptable. We all want to see the cost a bad deal for the American people. leadership. There was a discussion on curve go down and see overall health Coming back to the special deals, the floor last week between Senator care costs go down. But the ironic this is not the way to legislate. To MCCAIN and Senator DURBIN in which thing is, according to the CBO, the red carve out deals, to go and try and find Senator MCCAIN said: They are writing line represents what happens if the bill or buy or however you want to charac- this amendment behind closed doors. proposed by the Democratic majority terize it that sixtieth vote is essen- We don’t have any idea what is in it. actually becomes law. The cost curve is tially what we are talking about. These The Senator from Illinois, the No. 2 bent up. We will actually spend more are special goodies packed into this bill person in the Democratic leadership, on health care than we are spending essentially because the majority de- said: I am in the dark just like you are. today, even the year-by-year twice the cided that rather than trying to in- You had a handful of people who were rate of inflation increases in health clude Republicans and pass it with Re- adding 400 pages of content to the 2,100 care premiums today. publican votes, they had to pass it with pages we already have. The Senator from Wyoming is abso- all Democrats which meant that every In addition, there is another amend- lutely right to be offering amendments one of the Democrats had tremendous ment that adds another 300. We are to address the issue of premiums. This leverage. Clearly, they decided to use talking about 2,700 pages that will re- bill does not do anything to reduce pre- it. There are lots of carve-outs, lots of order and restructure literally one- miums for most Americans. About 10 special deals in this that cost the sixth of the entire American economy. percent of Americans, because of the American taxpayers hundreds of mil- Right now what we are being told is subsidies in the bill, would get their lions of dollars in additional spending that we are not going to be allowed to premium costs reduced, but 90 per- simply because they wanted to get this offer amendments to that humongous cent—we are told by the CBO—would done by an artificial deadline and piece of legislation. When you get this see their premiums stay the same or go wanted to do it with all Democratic much legislation coming at you and re- up. When I say stay the same, it means votes. ceiving this on Saturday, not having go up at the current rate of twice the I say to my colleagues, this process the opportunity to read it for the first rate of inflation. Worst-case scenario, itself, when the American people find time, is why we have been saying we if you are buying your insurance in the out about particularly this latest deal, need to push this back and not try to individual marketplace, you will see smells. I don’t think they are going to jam it through before the Christmas your insurance premiums go up above like it. I don’t think they are going to holiday. You find all kinds of things in and beyond this by 10 to 13 percent. like the end product when they find these bills. Sometimes people take Health care costs for 90 percent of out it will raise insurance premiums. credit for those being there. Some- Americans, the best they can hope for, Mr. BARRASSO. I try to stay in times they don’t. We have had a debate is the status quo which is year-over- close touch with the people of Wyo- about some of the provisions that ben- year increases that are twice the rate ming. I go home every weekend. We efit specifically Nebraska. You have of inflation. If you are one of the un- have not been able to do that the last this Medicaid provision that requires lucky who buys their insurance in the couple of weekends so I have had tele- the taxpayers of the other 49 States to individual marketplace, your pre- phone townhall meetings. I know the subsidize and pay the Medicaid match- miums go up by another 10 to 13 per- Senator from Tennessee has done the ing share for the State of Nebraska cent. This ought to be about driving same. There is a way people can push a which will cost millions and millions of down health care costs and getting pre- button to indicate whether they are in dollars. The Senator from Arizona miums under control. favor or against. Ninety-three percent mentioned this late add, a $100 million The overall cost of health care in this of the people of Wyoming are opposed item for construction of a university country represents about one-sixth of to the bill the Democrats are trying to hospital which, again, is being reported our entire economy. If this bill passes, jam through in the middle of the night. as being inserted by the Senator from according to the Congressional Budget I know the Senator from Tennessee has Connecticut. You have all these sorts Office, according to the Actuary of recently had telephone townhall meet- of deals that get made to try and get CMS, health care spending will no ings with his constituents because he that elusive sixtieth vote that are now longer be one-sixth of the economy; it was not able to be home personally coming to light. The American people will be more than one-fifth. Because if with them. Maybe the Senator wants have a right to know it. Frankly, Mem- this bill passes, health care spending to share with us some of the experi- bers of the Senate who have to vote on will go up to about 21 percent of our ences he has had and some of the mes- this have a right to know what is in gross domestic product. sages he has heard from the fine folks these volumes of pages, 2,700 pages, Tell me, what does this bill do then of Tennessee. that will spend $2.5 trillion. The origi- to get costs under control? If we are Mr. ALEXANDER. Madam President, nal 2,100-page bill spent $1.2 billion per driving up the cost of health care for the telephone townhalls are inter- page, $6.8 million per word. It creates individuals in the form of higher pre- esting. This is the 21st consecutive day

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But maybe the Second question: Do you support the tisan bill with so many questions and strategy has been to keep us here talk- health care bill moving through the so many concerns. ing to each other, bring the bill up in Senate? On this one, 1,496 said no, or 75 So I wonder if my friends from South a snowstorm, pass it in the middle of percent. 352 said I don’t know, which is Dakota and Wyoming—I know they the night and go home for Christmas, 18 percent, and 154 said yes, that is 8 have thought a good deal about this and the people won’t find out what we percent. step-by-step approach toward actually are doing until it is too late. One way No. 3: Do you agree that Congress solving the real problem of health care to find out is tele-townhalls. I was doesn’t do comprehensive legislation costs. skeptical before I did one but it is a well and ought to go step by step to Mr. THUNE. If the Senator will yield pretty interesting way to stay in touch bring health care costs under control? on that suggestion of small business with people from Tennessee. You get On this question, 1,285 said yes, that is health plans, doesn’t that enjoy wide on the telephone and an automated 80 percent, 14 percent said I don’t know support among small businesses in this system calls thousands of people and and 7 percent disagreed. country? says: The Senator from Wyoming or Il- I have often heard our friends on the Mr. ALEXANDER. It clearly does. It linois or North Carolina or Tennessee other side say: Where is the Republican enjoys widespread support everywhere, wants to talk with you about health bill? My response has been, day after except the Senate. When Senator ENZI care. People can either stay on the day, if you are looking forward to see- brought it up, it was rejected by our phone when they get the call or they ing the Republican leader role a wheel- friends on the other side. can hang up. What normally happens is barrow in here with a 2,700-page Repub- Mr. THUNE. If I might continue, the a person stays on the call, this time a lican comprehensive bill, you will be one thing that strikes me about this surprisingly large number of people waiting forever. We have a different ap- proposal that, as I said before, now is, in totality, 2,700 pages, is that it does stayed on the call, because of their proach. Our approach is to set a clear not enjoy any support from any small strong interest in this issue. goal—reducing cost. The bill we are business organization that I know of. The other night I did the phone call voting on increases costs. Our goal is Maybe there are some out there I can- between 7:30 and 8:30. I called to about to find five or six steps to go in the di- not speak to. But I do know the organi- 18 west Tennessee counties, including rection to reducing costs. Shelby, which is Memphis, and as re- Without going into detail, although zations that represent small businesses that we are all well acquainted with— ported to me by the service, about the Senators from South Dakota or National Federation of Independent 30,000 people were on the telephone Wyoming may want to, we focus on Business, the Chamber of Commerce, sometime during that hour, with a five or six steps that would clearly re- the National Association of Manufac- maximum number of 3,016 on the call duce health care costs. By that, I mean turers, the National Association of at any one time. Someone might pick your premium, the cost of your govern- Wholesalers and Distributors, builders up the phone and say: Senator BAR- ment. And once we do those five or six and contractors, electric contractors, RASSO is on the phone. They might steps, we could go on. We could do that franchise associations—I can go right tune in for 15 or 20 minutes and then without taxes, without mandates, down the list—all say this does nothing hang up. Maybe they have to cook din- without running up the debt, without a to lower their costs. In fact, it in- ner or the ball game comes on. Maybe big bill with lots of surprises. Just to creases the cost of doing business, in- they get tired of talking to you, but take one example—and then I will yield creases the cost of doing health care. they are on for 15 or 20 minutes. During to my friends from Wyoming and South What they have argued repeatedly is that time, I was able to take a number Dakota—one of those examples is the one of the suggestions the Senator of questions. After it was over, 563 mes- small business health care plan. The from Tennessee mentioned, that small sages from constituents were sent to current bill, the Democratic bill, has in business health plans would drive their my Web site. it a credit for small businesses, but we health care costs down, which is why It was interesting to me. People who would argue that by the time small they have been such strong advocates know my history, know that to be business men and women get through for this over the years. elected Governor 30 years ago, I walked paying the mandates and the taxes the I guess the other question I would across the State of Tennessee. Instead bill also imposes, it is not going to be ask of my colleague from Tennessee is, of going to a Republican meeting or a much help to them. would an approach, a suggestion like rotary club, I would visit with random What we have is a bill that would small business health plans require tax people during my walk. It took me 6 allow small businesses to pool their re- increases that would hit small busi- months and I would see 1,000 people a sources. In other words, if you are a nesses? day. These random phone calls kind of small business man or woman and you Incidentally, the latest version with reminded me of that. It was as if the have 60 employees and 2 get cancer, the managers’ amendment, which we people were randomly selected. They suddenly the costs of those 2 employees just received Saturday, increases the were not on any Republican list or prohibit you from providing insurance tax increases in the bill that were pre- Democratic list or list of doctors or pa- to the other employees. But if you viously $493 billion and are now $518 tients. They were just in the could pool your resources with small billion. As the Senator mentioned, phonebook. They talked and acted like businesses all around the country, then with the tax credit businesses get, they they were normal citizens who I had in- the pool would be large enough that up that a little bit but not enough to terrupted after dinner, probably be- you could offer insurance. help most small businesses in light of cause it was 6:30 to 7:30 in that part of That proposal has been made by Sen- the $518 billion in tax increases in the Tennessee. I was able to ask those citi- ator ENZI. It has been through the first 10 years, and when it is fully im- zens three questions. I am not about to HELP Committee. The Congressional plemented it will be about $1 trillion. say this is a Gallup poll of Tennessee, Budget Office said it did not add to the But the payroll tax that is going to hit because I know that surveys like that deficit. In fact, it reduces the deficit, a lot of small businesses was increased have to be done in a scientific way, but and it would permit 750,000 more em- dramatically in the managers’ amend- after being here for 21 straight days, ployees of small businesses to be in- ment. The individual mandate was al- not able to go home because we have sured and their premiums would be most doubled in the managers’ amend- been debating this bill, these opinions lower than they otherwise would be. ment. So the taxes in the bill go up are straws in the wind. That is a single step to moving toward with this proposal.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00034 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32940 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 I guess my question is, with all these would make a lot of sense, and I think ment but in a personal account, so tax increases that are going to have a they would enjoy tremendous support they could purchase health insurance crushing impact on small businesses, among small businesses, which create within a 3-year period. The money does a suggestion such as the one made the jobs in this country, as well as would accumulate. That amendment by the Senator from Tennessee for among the American public. was rejected as well. small business health plans require tax So I thank the Senator from Ten- So we have lots of ideas, good ideas, increases or Medicare cuts, which is nessee for pointing out one of the many to help people with affordable care, what is going to be necessary to fi- things Republicans are for and which available care, and yet one after an- nance this 2,700-page behemoth? we have tried to get in the debate. other they have been rejected in a step- Mr. ALEXANDER. I thank the Sen- I know the Senator from Wyoming by-step process to try to find ways to ator from South Dakota. The answer is has advocated for many of these same solve the health care crisis we know no. The difficulty with a big, com- types of initiatives and solutions. As faces the country. All 100 Members of prehensive plan is it sounds good but he mentioned earlier, he was prepared the Senate know we need to find ways has lots of unintended consequences. If to offer an amendment to address the to make health care more affordable our real concern right now is reducing issue of premiums, but it looks as if we and to work on high-quality care. costs in health care, then the idea of a are going to be prevented from doing It has been fascinating to see the small business health care plan that that. dean of the Johns Hopkins Medical has no new taxes and no new mandates Mr. BARRASSO. Our friends at the Center and the dean of Harvard and but creates opportunities for small University of Minnesota said that if those who have looked at this bill businesses to pool their resources and people were allowed to shop across closely say that the people who are offer more insurance at a lower cost to State lines, shop around for insurance supporting this are living in collective their employees would seem a logical that is better for them and their family denial, that this bill is doomed to fail, place to start. and their personal situation, we would that it will raise the cost of care, not Mr. THUNE. I appreciate the Senator have 12 million more Americans in- lower the cost of care, and will do for his work on that issue. It is a view sured today than we have now, without nothing to improve quality. I share, a proposal I have been a big ad- a single page of legislation. That is all Mr. THUNE. If the Senator from Wy- vocate of going back to my days in the we need to do: allow people to shop oming would yield on that point, that House of Representatives and one across State lines. But when we talk is why I think day after day after day— which, as the Senator from Tennessee about and look at this bill, which has and I have said—there is a pattern noted, has tremendous support among mandates, there is going to be a man- emerging here in the Senate where the small businesses across the country. date for people to buy insurance. majority comes down and establishes About the only place it does not have One of the amendments I tried to the need for health care reform, which majority support is here in the U.S. offer yesterday that I thought made a we all acknowledge, and illustrates ex- Congress because maybe it makes too lot of sense for young people was that amples of those who have fallen much sense. for individuals under the age of 30 or through the cracks, which we all know But it seems to me there are sugges- for those making less than $30,000 a examples exist—all of us have dealt tions and solutions out there which do year, they would be exempted from the with those in our individual States— not require $1⁄2 trillion of tax increases mandate, the individual mandate that and then proceeds to attack Repub- on small businesses, which every small they have to buy insurance. licans for not having their own ideas, business organization has come out and I was involved in a discussion on a which we have just mentioned there said: It is going to drive up our cost of college campus in a debate on this are lots of good Republican ideas which doing business, and at the end of the topic, and in talking to the students, do not raise taxes, which do not cut day, it is going to raise our health care they were astonished to learn—because Medicare, and actually do something to costs—and does not require these steep they were not focused on this; they reduce premiums. But that seems to be Medicare cuts that the Senator from were focused on their studies and work- the strategy employed and the pattern Wyoming has alluded to over and over ing—they were astonished that they that emerges in the rhetoric day after again and the impacts those will have are all going to have to buy, as a mat- day down here from the other side. on the delivery of health care to sen- ter of law, if this passes, health insur- The one thing I do not hear is them iors across this country but, rather, it ance immediately, and if they do not, coming down here and talking about would bend the cost curve down with- they are going to have to start paying what this 2,700-page bill is going to do out tax increases and Medicare cuts. a tax or a fine, depending on how you to reduce health care costs, because if Another example of that, I would describe it. we all submit to the experts on this— argue, would be allowing for interstate So in my amendment, I said, for which, as I said earlier, the Congres- competition, allowing people to buy those up to the age of 30 and making sional Budget Office is sort of the ref- their insurance across State lines, under $30,000 a year, let’s exempt them eree. They do not have a political agen- which is a suggestion we have made from the mandate. That amendment da, or at least they are not supposed to. over and over on our side of the aisle. was rejected. The Actuary at the Centers for Medi- According to the Congressional Budget Then I said, well, if they are going to care and Medicaid Services does not Office, both small business health plans do this and force these people to buy have a political agenda, or at least and buying insurance across State insurance, and if they do not buy insur- they are not supposed to. They are sort lines actually would reduce health care ance, they have to pay these excessive of considered to be an umpire on this. costs and would do it without raising fines or taxes—or however you want to The Joint Committee on Taxation, taxes or cutting Medicare, which, to define it—I said, how about that the which looks at the distributional im- me, would make a lot of sense, espe- penalties these people would have to pacts of tax policy, is a referee and is cially when you have an economy in re- pay, if they choose not to buy insur- not supposed to have a political agenda cession, 10-percent unemployment, a ance—because it is going to be a lot in all this. They all come to the same $1.5 trillion deficit last year and an- cheaper to not buy insurance and to conclusions with regard to premium in- other $1.5 trillion deficit this coming just pay the tax—what if that money creases in this bill. year, and when you are talking about a could go into a personal account so So if the overall objective is to re- $2.5 trillion cost in the growth of gov- that person can then use the money to duce the cost of health care, and if, in ernment here in Washington, DC, to then buy insurance? So it would be fact, your legislation, according to all implement these 2,700 pages. kind of like a savings account, so the the referees, all the umpires, all the ex- Some suggestions along the lines of money would be there for them to buy perts, not only increases premiums for the one mentioned by the Senator from insurance. So individual mandate pen- most Americans but increases the over- Tennessee and some of these others alties would accrue not to the govern- all cost of health care, which is what

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Pro- down and talking about the substance a column by David Brooks in the New viders will have the same perverse incen- of the bill because the substance of the York Times on December 18. tives. As a result, prices will skyrocket while bill does not accomplish the stated ob- There being no objection, the mate- efficiencies will not. There will be a bipar- jective, which is to reduce the overall rial was ordered to be printed in the tisan rush to gut reform. cost of health care and get premiums RECORD, as follows: This country has reduced health inflation under control for families and small in short bursts, but it has not sustained cost [From the New York Times, Dec. 18, 2009] control over the long term because the deep businesses in this country. THE HARDEST CALL flaws in the system produce horrific political It is also hard, I would argue, because The first reason to support the Senate pressures that gut restraint. of the $518 billion of tax increases that health care bill is that it would provide in- Fourth, you can’t centrally regulate 17 are in here and the unified opposition surance to 30 million more Americans. percent of the U.S. economy without a raft of the entire small business commu- The second reason to support the bill is of unintended consequences. nity, which creates 70 percent of the that its authors took the deficit issue seri- Fifth, it will slow innovation. Government jobs in this country, to talk about how ously. Compared with, say, the prescription regulators don’t do well with disruptive new drug benefit from a few years ago, this bill is technologies. this can be anything but detrimental Sixth, if this passes, we will never get back to job creation. This is going to cost us a model of fiscal rectitude. It spends a lot of money to cover the uninsured, but to help to cost control. The basic political deal was, jobs. I think every business organiza- pay for it, it also includes serious Medicare we get to have dessert (expanding coverage) tion has made that abundantly clear. cuts and whopping tax increases—the tax on but we have to eat our spinach (cost con- And all the analysis of this legislation high-cost insurance plans alone will raise trol), too. If we eat dessert now, we’ll never that has been done comes to the same $1.1 trillion in the second decade. come back to the spinach. conclusion. The bill is not really deficit-neutral. It’s So what’s my verdict? I have to confess, I Mr. BARRASSO. When you take a politically inconceivable that Congress will flip-flop week to week and day to day. It’s a guess. Does this put us on a path toward the look at what the Centers for Medicare really make all the spending cuts that are there on paper. But the bill won’t explode real reform, or does it head us down a valley and Medicaid Services has done, which in which real reform will be less likely? is the group that oversees Medicare, the deficit, and that’s an accomplishment. The third reason to support the bill is that If I were a senator forced to vote today, I’d they have said that 10 years from now, the authors have thrown in a million little vote no. If you pass a health care bill with- if this goes through, you are still going ideas in an effort to reduce health care infla- out systemic incentives reform, you set up a to have 24 million uninsured, you are tion. The fact is, nobody knows how to re- political vortex in which the few good parts going to have 18 million more on Med- duce cost growth within the current system. of the bill will get stripped out and the ex- icaid, the program the Senator from The authors of this bill are willing to try pensive and wasteful parts will be en- anything. You might even call this a trenched. Tennessee appropriately referred to as Defenders say we can’t do real reform be- Burkean approach. They are not fundamen- having a bus ticket for a bus that is cause the politics won’t allow it. The truth tally disrupting the status quo, but they are not going to come, because that is is the reverse. Unless you get the funda- experimenting with dozens of gradual pro- mental incentives right, the politics will be what has happened. Half the doctors in grams that might bend the cost curve. terrible forever and ever. the country do not take care of pa- If you’ve ever heard about it, it’s in there— tients on Medicaid because the reim- improved insurance exchanges, payment in- Mr. ALEXANDER. Most of us—we bursement is so low that they cannot novations, an independent commission to are pretty split up here: 60 there, 40 afford to continue to care for those cap Medicare payment rates, an innovation here. They are for it, and we are people. Five million people will lose center, comparative effectiveness research. against it, this bill anyway. the insurance they get through work, There’s at least a pilot program for every The PRESIDING OFFICER. The mi- and health care costs will go up. The promising idea. nority time has expired. The fourth reason to support the bill is Mr. ALEXANDER. I thank the Pre- cost curve will go up instead of going that if this fails, it will take a long time to down. But the whole purpose of this get back to health reform. Clinton failed. siding Officer and I yield the floor. was to help drive the cost down. Obama will have failed. No one will touch The PRESIDING OFFICER. The Sen- Then, additionally, they said that 20 this. Meanwhile, health costs will continue ator from California. percent of providers—20 percent of the their inexorable march upward, strangling Mrs. BOXER. Madam President, we providers—of health care in this coun- the nation. heard our Republican friends say it is try—and that includes physicians, The first reason to oppose this bill is that very hard to defend our bill. Maybe it nurse practitioners, medical clinics, it does not fundamentally reform health is hard for them, but it is not hard for care. The current system is rotten to the the American Medical Association, the hospitals—20 percent of the providers bone with opaque pricing and insane incen- in this country, under this plan, 10 tives. Consumers are insulated from the AMA, which has endorsed our bill. It is years from now, will be unprofitable, costs of their decisions and providers are not hard for the American Heart Asso- unable to keep their doors open. punished for efficiency. Burkean gradualism ciation, which has endorsed our bill. It So we have heard about sweetheart is fine if you’ve got a cold. But if you’ve got is not hard for the American Cancer deals. We have heard about taxes going cancer, you want surgery, not nasal spray. Society Action Network, which has en- up. We have heard about Medicare cuts. If this bill passes, you’ll have 500 experts in dorsed our bill. The American Hospital And what we have seen is one promise Washington trying to hold down costs and Association has endorsed our bill. Fam- after another made by the President 300 million Americans with the same old in- ilies USA, the Business Roundtable, centives to get more and more care. The that has been unfulfilled and actually Congressional Budget Office and most of the the Small Business Majority—we hear reversed by the bill we see ahead of us. experts I talk to (including many who sup- colleagues say small business opposes So I ask my friend from Tennessee, port the bill) do not believe it will seriously our bill. The Small Business Majority wouldn’t he agree that in the next 2 bend the cost curve. Organization supports it. And how days, the best thing for the country The second reason to oppose this bill is about the AARP, which represents our would be to have this bill not pass the that, according to the chief actuary for seniors, millions of seniors. Those are a Senate and instead go back in a step- Medicare, it will cause national health care few. They not only defend our bill, they by-step way and regain the trust of the spending to increase faster. Health care support our bill. spending is already zooming past 17 percent This is indeed an important moment American people? of G.D.R. to 22 percent and beyond. If these Mr. ALEXANDER. I certainly do pressures mount even faster, health care will in our Nation’s history as we approach agree with that. squeeze out everything else, especially on a final vote on major health care re- I think most Americans, when pre- the state level. We’ll shovel more money form legislation. I think whenever you sented with a problem, would not try into insurance companies and you can kiss are trying to change something, you

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00036 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32942 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 have to take a look at how things are 60 votes we are forced to get—not 51, a He can only cover the employees, not at the moment. So why is it we voted majority, but 60 votes because of a Re- their families. He feels terrible about to change our current system? There publican filibuster—if we get those 60 it, and he says he may have to cut off are certain numbers that I think ex- votes each time, there is hope for you his employees if prices keep going up. plain it. The first number is 14,000. We because we are going to fix that entire I want to say to this fine small busi- know that every single day 14,000 of our problem. ness owner: Douglas, help is on the neighbors lose their health insurance Mr. Ronald Kim says: way. through no fault of their own. They ei- I am in the construction industry and my Mrs. Linda Schumacher wrote—and ther lose their job, they can’t afford to work is very slow. this is the one I will close with in this keep up the health insurance or they He says he is in the design industry. series of stories: have a condition and the insurance I am in danger of becoming financially ill I am a Republican. company walks away from them or and I am looking for ways to stay healthy, Let me repeat what she writes: they are priced out of the market. and one way may be to eliminate my medical I am a Republican, and my husband and I insurance. It is a significant part of my Fourteen thousand a day. That is are small business owners. The Senators and budget. This may, heaven forbid, lead me to cruel, and we need to change it. Congressmen of both parties who are against financial ruin if I get injured or sick. This is Sixty-two percent of bankruptcies President Obama’s plan have their own in- my situation. are linked to health care crises. We are surance, and it is my understanding that it the only nation in the world where peo- I want to say to Mr. Kim: Help is on does not cost what we pay. They do not un- ple go broke because they get sick. the way. derstand what a huge expense this is. Please If we do nothing, 45 percent of an av- Ms. Madeleine Foot wrote—these are listen to the middle class who are in our po- erage family’s income will go for pre- all Californians, my constituents: sition or who no longer have insurance. It miums in 2016. I ask everyone to think I recently turned 25 and I lost my health keeps me up at night worrying. This time about it, paying 45 percent of your in- coverage under my parents. I attempted to the Republicans have it wrong, and they get coverage under a Blue Cross plan created need to know. Please push the health plan. come for premiums. It is not sustain- The insurance companies only care about the able. What about food? What about for young people my age, but because I had taken medications, I was denied. I applied bottom line, not people. clothing? What about shelter? Can’t do again for another plan, was offered a plan I wish to say to Mrs. Schumacher: it. with a $3,000 deductible, and it was $300 a Thank you for putting aside party poli- We are 29th in the world in infant month on top of that. As a young person mortality. We come in behind Cuba. We tics, because this isn’t about Repub- working in a restaurant, repaying student licans and it isn’t about Democrats and come in behind Singapore. We come in loans and trying to make it on my own, this behind South Korea. We are 29th in the is a huge financial burden. I cannot afford an it isn’t about Independents. It is about world on infant mortality because peo- insurance that charges me so much and all of us together. ple don’t have good insurance or they won’t be any benefit for me until I have What happens now? We are hearing don’t have any insurance. shelled out a huge portion of my income. the polls, and the polls show Americans Fifty-two percent of women—fifty- To Madeleine Foot I say: Help is on don’t want us to act. I understand why. two percent of women—don’t seek the the way, if we can break the Repub- There has been so much misinforma- health care they need. They either put lican filibuster. tion. Senator DURBIN, our assistant it off or they never get it because they Mr. John Higdon wrote: majority leader, and I were talking may not be insured or they are afraid As a self-employed person, I had a pace- about the misinformation that is on of the copays. They are afraid of what maker implanted. The cost was borne en- this floor from the other side day in it would cost. They may have limits on tirely by me at prices much higher than any and day out, and I believe much of it, insurance company would have had to pay. if I might say, is purposeful. If you lis- their policies. We need to change that. That was a wakeup call to get health insur- The United States spends twice as tened to my Republican colleagues ance. I am told by every health insurance over the past few days and weeks, they much on health care as most other in- company I have contacted that no one will dustrialized nations. So what is the offer me health insurance at any price with have trashed this bill and they have message here? We spend a huge a ‘‘preexisting heart condition.’’ trashed the process. Over the weekend amount. We are not doing very well in I wish to say to Mr. Higdon: Help is the Republican leader said health re- outcomes. By the way, I think we are on the way. form is a legislative train wreck of his- 24th in life expectancy in the world— Dr. Robert Meagher, a pediatrician toric proportions. That is a direct 24th. We must do better. with Kaiser Permanente for over 30 quote. I wish to share with my colleagues years, do you know what he wrote and Earlier this month Senator COBURN some of the letters and e-mails that told me? That he has to fake—he is used more inflammatory language have been sent to me from Californians pressured to fake a diagnosis because when he said to seniors—I am quoting that personalize the statistics I spoke when a parent comes in with a young Senator COBURN: I have a message for about. child with asthma, they beg him not to you. You are going to die soon. Mr. William Robinson wrote: write down asthma but write down If you want to know what I am about to be laid off from the job I bronchitis, because if he writes down fearmongering is, that is the best ex- have had for 19 years. My biggest fear is not asthma, that child will have a pre- ample I can give you. being employed, but being able to find and existing condition and when she turns I decided to go back and look at the get affordable health care. I am 60 years old. past CONGRESSIONAL RECORDs. I I have a preexisting condition that will for 21 she won’t be able to get insurance. Imagine, in America, a physician being thought: Have Republicans spoken like certain make it impossible for me to buy this over the years every time we have health insurance. pressured to lie on a form because of a health care system that is so cruel. tried to do some health care, every Mr. and Mrs. Gilbert De La Cruz time we have tried to make life better wrote: So, Dr. Meagher, we are going to change things here if we can break this for people, such as Social Security? I We are at the point of losing our home be- will let you be the judge. cause we have spent our savings on medical filibuster. and prescription drugs. I am 67, retired, and Mr. Douglas Ingoldsby wrote: In 1935, on the floor of the House of my wife is 62. Because of the Medicare gap in I own a small business. I employ 11 people. Representatives during the debate on prescription drug coverage, we have had to I have been in business in California since Social Security, Republican Congress- pay $600 a month on prescription drugs. It’s 1972. man Jenkins of Ohio said—a Social Se- a huge portion of our monthly income. We He says: curity bill, remember, which hadn’t will be selling our home shortly and perhaps I used to provide health care for all my em- passed: moving in with one of our children because ployees and all the members of their fami- This is compulsion of the rankest kind. Do there doesn’t seem to be any option. lies, and if I want to remain profitable not be misled by the title. The title says Well, I want to say to Mr. De La enough to stay in business now, I can’t do it ‘‘Old-Age Benefits.’’ Shame on you for put- Cruz: Help is on the way. If we get the anymore. ting such a misleading and unfair title on

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00037 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32943 such a nefarious bill. Old age benefits? Think people are going to have, because our insurance; otherwise, they will get tax of it. Oh, what a travesty! . . . Mr. Chair- colleagues say: Oh, we are raising reve- credits. That is very important. man, what is the hurry? Nobody is going to nues but there are no benefits right This bill is going to benefit our sen- get a dime out of this until 1942 . . . what is away. iors. That is why it is endorsed by the the hurry about crowding an unconstitu- Let’s talk about what the benefits tional proposition like this through the AARP. We eliminate the prescription House today? are. There will be a $5 billion high-risk drug coverage gap. That is the dough- pool immediately for people with pre- nut hole. We extend the life of the If you listen to some of my col- existing conditions who cannot find in- Medicare trust fund by 9 years. We re- leagues, you will hear the same thing. surance. There will be reinsurance for duce waste and fraud in Medicare. We What is the rush? As a matter of fact, retirees, so if you are retired and you provide for free yearly wellness visits they had four or five amendments to are getting your health care benefit for seniors. This bill saves Medicare. send it back to committee. What is the and something happens to your com- This bill makes our seniors stronger. rush? pany, there will be reinsurance so you The rush is that 14,000 people are los- They will have more benefits, and they can still get your benefits. We close ing their health care every day. The can never lose their guaranteed bene- that doughnut hole for the Medicare rush is that 62 percent of bankruptcies fits. recipients who fall into it and suddenly Small businesses will be able to re- are linked to a health care crisis, and they cannot afford their prescription duce their costs, again, by getting im- in 2016 our people will be paying almost drugs. There will be billions of tax mediate tax credits. In 2014, they will half of their income for premiums. Yes. credits—billions—up to 50 percent tax be able to access the exchange, as will We have to do this, and we started it 7 credits for small businesses. That is self-employed people. They will have months ago, and 100 years ago Teddy why we have the support of so many the power of big business behind them Roosevelt, a Republican President, put small businesses. For new policies, no as they go into those exchanges. it in his platform. What is the rush? discrimination against children with I want to talk about public interest What is the rush? provisions. I wanted a public option, I wish to tell my colleagues about an- preexisting conditions, and children let me be clear, because I felt it would other Republican Congressman, J. Wil- can stay on their family’s policy until keep the insurance companies honest. liam Ditter of Pennsylvania. This is they are 26 years of age. What else are the immediate and But let me tell you what we have in what he said during the debate on So- near-term changes for the better? For here that are definitely public interest cial Security: new policies, no lifetime limits, no provisions. We expand Medicaid. That . . . security for the individual, whether more rescissions. They cannot walk is a public plan to cover an additional worker or aged, will be a mockery and a sham. away from you when you get sick. 14 million people, and that starts in They are required to cover essential 2014. That is 1.5 million Californians. In This is what he said about Social Se- preventive health benefits such as my State, the Federal Government will curity. mammograms. It prohibits discrimina- pay the full fare for those added people And it will allot to our people the role of tion by employers based on salary of for 3 years, and after that, far more puppets in a socialistic State. their employees. An employer cannot than we get paid now. HHS will set the That is what he said back then. I tell say: If you earn over $250,000, you get initial rules for the State exchanges. you, if you ask Republicans who are these great benefits, but if you earn So those getting into the exchanges getting Social Security, Democrats under $50,000, you get a worse array. have to be fair. The OPM plan—that is who are getting Social Security, Inde- By 2011, standards for insurance over- the plan that will be part of the ex- pendents who are getting Social Secu- head costs go into place. If your insur- change—will be set up by the govern- rity, they will all tell you the same ance company spends too much on ment, the Office of Personnel Manage- thing: Keep your hands off it. It works. overhead and too much on executive ment. It is good. It is fair. It is insurance. pay, let me tell you what happens. Again, community health centers. A It is what we did way back then. They have to rebate to you, the policy- basic plan can be created by the States, In 1965, when Medicare passed, health holder. We also see increased funding which I think is very important. I care for those 65 and up, Republican for community health care centers. thank MARIA CANTWELL for working so Senator Carl Curtis said: This is going to make a huge dif- hard on that issue. It is socialism. It moves the country in a ference. There will be a national Web If people tell you we do not have any- direction which is not good for anyone. site to shop for affordable insurance. thing to do with public options, they Years later, we know Newt Gingrich There will be a long-term care program are really not right. You have to look when he was Speaker of the House said that is voluntary into which you can carefully at this bill. he wanted to see Medicare ‘‘wither on buy. Insurance companies with unrea- I want to talk about the deficit. We the vine,’’ his words. sonable premium increases can be reduce the deficit between 2010 and 2019 In 1995, while seeking the Republican barred from the exchanges that will be by $132 billion, and between 2020 and nomination for President, Senator Bob set up in 2014. So they will be making 2029, there is up to a $1.3 trillion deficit Dole said: sure they do not increase your pre- reduction, according to the Congres- I was there in 1965 fighting the fight, vot- miums beyond a reasonable amount. sional Budget Office. That is a non- ing against Medicare, because we knew it This bill will benefit the insured in partisan office. This bill reduces the wouldn’t work in 1965. one way—I do not think people under- deficit. I am going to say it one more So when you hear our Republican stand this—by 2014; 62 percent of fami- time. This bill reduces the deficit. And friends say, Oh, my goodness, they are lies will no longer face unsustainable the reason is, we invest in prevention, making a lot of savings in Medicare; premium costs. If you are a family of and that pays off. We finally will be this is bad for the seniors, please, four and make less than $88,000 a year, able to say to the insurance companies: please, which party has stood for pro- you will never have to pay more than Stop your gouging. And that pays off. tecting our seniors? It is not a matter 9.8 percent of your income on health We do have competition now because of being partisan; it is just the fact. insurance premiums. This is an amaz- we will have that special plan run by The echoes of the past fill this Cham- ing thing most people do not focus on. OPM, the State option MARIA CANT- ber. I just explained that the nonpartisan WELL put in there. This is why we see I am convinced now in 2009 that hope studies show—and this is important— the reduction, including taking the and reason and determination and good that they will be paying, the average fraud and the waste out of Medicare. policy will triumph over fear and ob- family, 45 percent of their income for We do not need fraud and waste. struction and the status quo. health care. In 2014, people in this Here is how I want to close. Health Let’s look at the immediate and country will not have to pay more than care coverage for all Americans has near-term changes for the better that 9.8 percent of their income on health been such an elusive goal for nearly a

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00038 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32944 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 century. If you look at Republican Mr. KERRY. I thank the Chair. will restrain a group of insurance com- Presidents, Democratic Presidents, Re- Let me begin by saying I also lis- panies that have shown no predilection publican Congresses, and Democratic tened to our colleagues on the other to restraining themselves over these Congresses, we have tried it over and side of the aisle, particularly the Sen- past years. over again, and the status quo has al- ator from South Dakota, just a little If you are for the status quo, then ways prevailed. while ago. I was really struck by the you will vote no, the way our col- Our beloved friend, Senator Ted Ken- chart they put up showing Medicare leagues have voted. But the American nedy, whom we miss so much, particu- going up and up and up, and then they people are not satisfied with the status larly during a time such as this, fought talk to Americans, basically scaring quo. People in America understand for health care right here on the floor them, trying to say: If you pass this that health care costs are breaking the from the moment he became a Senator bill, it is not going to do anything to backs of families. They are breaking in 1962 to the moment he died. In an reduce the crisis in Medicare down the the backs of businesses. They are a op-ed in the Washington Post this past road. huge albatross around the neck of Friday, Ted Kennedy’s wife Vicki The reality is, that is all they American competitiveness. wrote: present, is the scary picture of a future Many of our companies have a harder Ted often said that we can’t let the perfect which they are not even describing ac- time competing because there is a be the enemy of the good. curately. They have had a year and a health care premium tax, if you will, I want to say to Vicki, she is exactly half—a year and a half—that we have for the uneven distribution of being right. Each of us could write this bill been working on this legislation, since sick in America. Obviously, if you are our way. Believe me, if I wrote a bill, it was announced in the Finance Com- sick in America, you get care at some point in time. It may well be that point to me it would be perfect. But to my mittee, on which I serve, and we held a in time is when you are on your death- friend in the chair, she would say: I can day-long—I think a 2-day long con- bed or when you are so sick that you fi- make it better. And all of us could. ference over at the Library of Congress nally go into the hospital, into an This is the legislative process. This is a and within the committee where we emergency room, and the emergency good bill. began the work, laying the groundwork Vicki goes on to say: and foundation for a new Presidency room becomes your first contact with the medical system or it becomes your The bill before the Senate, while imper- and for the work that has gone on this primary care facility. We have almost fect, would achieve many of the goals Ted year. Many of their Members took part 50 million Americans for whom that is fought for during the 40 years he championed in that. So there is no secret here as to true—50 million Americans who don’t access to quality, affordable health care for where we are. all Americans. This is a debate that has gone on in have health care. So they do not get an early screening, they do not get an He is not here to urge us not to let the United States of America since early determination of what may be this chance slip through our fingers. Harry Truman was President of the wrong with them. They do not get what And she says: United States and before. We all know somebody who has a health care plan So I humbly ask his colleagues to finish that President Teddy Roosevelt, a Re- gets, which may be a mammogram or a the work of his life, the work of generations, publican, put before the country the to allow the vote to go forward and to pass Pap smear or a PSA test for prostate notion that every American should be health-care reform now. As Ted always said, cancer, or any number of evaluations, able to have their sickness dealt with. when it’s finally done, the people will wonder perhaps early detection of diabetes. what took so long. Nobody has ever contemplated that We spend almost $100 billion in the I thank Vicki, not only for writing you ought to go bankrupt in order to United States for unnecessary dialysis that wonderful editorial but for actu- have health care. But, as we know, we and/or amputations that take place be- ally being in the Chamber when we have more bankruptcies in America— cause people weren’t able to go to a took that first vote to break down this health care bankruptcies—every year doctor earlier and learn that they had filibuster. than any other nation on the planet. I a type of diabetes that might have been I say to my colleagues, I am so proud think we are the only nation that real- able to be treated in a far less expen- that today we are moving closer to ful- ly knows health care bankruptcy. The sive and dramatic and personally cost- filling the promise of health care for stories we have heard—countless sto- ly way. all Americans, including the 40 million ries. The word ‘‘history’’ gets thrown Californians I am so privileged to rep- Earlier this morning—I guess to get around in the Senate probably more resent. I thank my colleagues for all my times correct—when we were here than it ought to. We often refer to the work they put into this bill. I spent at 1 in the morning, we heard the ma- something as being historic, where a lot of time on it myself, and this mo- jority leader talk about those very sometimes it is a reach. There is no ment is very poignant. I hope we pass poignant, moving situations of individ- question that we are on the threshold it. uals in Nevada. We heard the Senator of an unbelievably historic moment in I yield the floor. from California. There are stories from the Senate. This is history we are liv- The PRESIDING OFFICER. The Sen- every Senator, from every State. Yet it ing here now. ator from Massachusetts. is only this dividing line, right here When I think of what we tried to do Mr. KERRY. Madam President, let down the center of this Chamber—it is in 1993 and 1994, when President Clin- me begin by commending the Senator only the Senators on this side of that ton was in office and we tried to pass from California for an outstanding dividing line who seem to be prepared health care—we got beaten back by presentation regarding this legislation. to try to address this issue. The fact is, false advertisements—Harry and Lou- I was listening to her in my office be- the managers’ amendment, which is ise—scare tactics, and I might add a fore I came over to the Chamber. I lis- now the pending business before the plan that didn’t quite pull the pieces tened to her over here. She laid out in Senate, brings us even closer to being together as effectively as we have. We a very careful, deliberate, and thought- able to address many of the major con- have learned a lot of lessons since then. ful way the realities about this legisla- cerns we have. We have had many fits and starts, with tion before us. I thank her for a terrific Senator after Senator has come to children’s health care, portability, and presentation. the floor and described the way in trying to deal with certain gender dis- I wish to pick up a little bit where which this bill does not do everything crimination or other discrimination she has left off. But let me inquire so I we want it to do. I have been a pas- within the systems. We have gotten lit- understand where we are. How much sionate supporter, as was Ted Kennedy tle pieces done. But all the time, the time is remaining on the majority and a lot of our colleagues, of a public basics of the system have been without side? component of this plan. Why? Because the reform necessary to bring down The PRESIDING OFFICER. The ma- I believe that is the best way to create costs and make health care more acces- jority side has 341⁄2 minutes remaining. the kind of competitive pressure that sible to more Americans.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00039 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32945 So I have no doubt we are reaching a ferent from what we do today, where are actually different practices be- moment of historic importance here. we don’t bundle it and say: Take care tween different hospital operations. I This is a moment where we are going of this patient, and all of your various happen to know this on a personal to finally provide access to almost all parts have to fit into a whole. Today, basis because my wife recently had an Americans. Thirty-one million Ameri- we pay each of the separate parts with- operation in one hospital system and cans are going to gain health care cov- out relationship to what their connec- they had a certain procedure to try to erage through this legislation when we tion is to the total care of a patient. It deal with the MRSA infection, and a pass it, and that will bring us up to 94 is unbelievably wasteful, ineffective, certain washing and disinfection proc- percent. sometimes redundant, it is noncommu- ess you went through, and I know other To give an example, in Massachu- nicative, and that is one of the reasons hospitals where they do not do the setts, where we passed health care re- why in America we don’t get the same same thing. form a couple of years ago, we man- outcomes for less money that people In addition, we are going to have dated that everybody be covered and get in Europe or in some other coun- health information technology reform we created a penalty for companies tries. adoption. There is going to be adminis- that don’t offer the insurance, but we But we have learned from the New trative simplification that would have a pool that helps provide coverage England Journal of Medicine, which is standardize and streamline insurance to people who can’t afford it. We now a highly respected medical journal, paperwork. I mean, if you go to the have 97.6 percent of all our citizens that the bundled payments for chronic ATM machine and pull out some covered in the State of Massachusetts. diseases and for elective surgeries money, it is about a penny or half a The fact is the premiums in the indi- could reduce health care spending by as penny per transaction. If you go to the vidual market, which is where it is much as 5.4 percent from 2010 to 2019. hospital, where they do not have tech- most expensive for Americans to go out Yet we don’t credit for that savings. nology managing the records and peo- and buy health insurance, went down They do not talk about it. But common ple are doing it, it is about $20 to $25 by 40 percent. The premiums went sense tells us, because we have seen it per transaction to pull the records. In down by 40 percent in Massachusetts where they have done these bundled the age of computerization and infor- for a quality of care that people love. payments, that you are going to reduce mation technology, it doesn’t make The premiums in the rest of the coun- the costs. sense, and all of us know that. But we try went up 14 percent. That is a 54-per- In addition, even if such savings only also know that because we are putting cent spread in the cost of premiums be- applied to half of the spending in the money on the table and incentives in tween those who got health care re- health care sector, the result would be place to help do that, we are going to form and those who did not. more than $900 billion of savings over be able to get additional savings; all of That is precisely what we are going the next 10 years. If bundled payments the savings that are on top of the $1 to be able to provide Americans—be- get expanded beyond the post-acute trillion of savings I have already ginning to provide Americans with care, and even half of the potential sav- talked about, and none of which gets this. One of the reasons we can’t pro- ings from bundled payments were real- measured when our colleagues come to vide it as effectively as in Massachu- ized in the Medicare Program during the floor to say what a terrible bill this setts is because there are certain the upcoming decade, these savings is. things we do in Massachusetts that the would translate to an additional .2 per- CBO has also grossly underestimated other side, or some folks, have pre- cent of savings per year or reduction in savings in the past. I am not picking vented us from being able to do here. program expenditures, and that would on CBO. They have had an incredibly Let me sort of lay it out here. There be more than $190 billion between 2010 hard job, and they have done an incred- are a couple of things that bother me and 2019. ible job. They have been completely about this. We keep hearing from our I have talked about $1 trillion—$1 overworked on any number of efforts, colleagues—and I heard this from the trillion—of savings that does not even where we have been asking for models Senator from South Dakota—that we get formally presented to the American and analyses. But it is automatic in a are not going to be able to save money people as part of this process because process that you are going to lose some in the legislation we are going to pass. of bureaucratic technical rules about things. In fact, nothing could be farther from what the budget applies to. Everybody According to the Generic Pharma- the truth. All of us know, as a matter on the other side of this aisle knows, as ceutical Association: of common sense, that many of the a matter of common sense, if you look In 1984, it was predicted that the Hatch- measures in this legislation are going at the experience, the way it has al- Waxman Act would save our country $1 bil- to reduce the cost of health care, and ready been proven in the marketplace, lion in the first decade. Now, generic medi- one of the reasons is that the CBO and if you apply your thinking to this, cines save more than that every three days. analysis is generally limited to the we are going to reduce the cost of Every 3 days we do what was pre- Federal budget. It doesn’t attempt to health care. dicted to happen in savings every 10 account for savings in the health care Similarly, large reductions in Fed- years. In the mid 1990s, the Congres- system that come from policies that eral health care expenditures are plau- sional Budget Office released an anal- are implemented through reforms. sible from the combination of other de- ysis showing that in 1994—the tenth an- For example: The CBO found only $19 livery system reforms. A lot of Ameri- niversary of the Hatch-Waxman Act— billion in government savings from cans aren’t aware of this, but here is annual savings of generics had reached transitioning toward post-acute bun- what we have. Accountable care orga- approximately $8 billion to $10 billion. dled payments in Medicare. But recent nizations. We don’t have that today. The new data released showed that by research in the New England Journal of Suddenly, we are going to have an ac- 1999—15 years after Hatch-Waxman be- Medicine suggests that bundled pay- countability in the care organizations came law—generics were generating $49 ments—bundled payment, for some- delivering service. That is going to pro- billion in annual savings. In the last body listening who doesn’t understand, vide savings. decade alone, generics have saved con- is when you take all the payments that We have incentives to reduce hos- sumers, businesses, State and Federal come to a hospital or to the providers pital-acquired infections. One of the governments $734 billion. who provide the care, and the pay- biggest single fears people have today I haven’t even talked about the ments are all put together for the var- in America when they go to the hos- wellness provisions or the prevention ious services that you get and they pital is that they are actually going to provisions that are in here. When we have to decide how to provide you get an infection in the hospital, and start getting all of America more those services in a cost-effective way the chances of coming up with a staph tuned in to the things we can do to pre- based on the whole universe of money infection or some other kind of infec- vent diseases by taking actions in our that has been put on the table. It is dif- tion are very real and very high. There lives, our lifestyles, in our diet, and

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00040 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32946 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 any other number of things, we can curity Act. In 1965, we passed Medicare. suggests that bundled payments for bring the cost of health care down in Medicaid came afterward. They op- chronic diseases and elective surgeries America. posed it. They opposed Medicare, one of could reduce health care spending by as We keep hearing about the secrecy the most important programs in the much as 5.4 percent from 2010 to 2019. and how this legislation has been hid- United States of America, that lifted Even if such savings applied to only den from folks for a long period of countless numbers of seniors out of half of spending in the health care sec- time. Again, that is not true. There is poverty. They said no. The insurance tor, the result would be more than $900 nothing in this legislation that we industry survived Medicare and Med- billion of savings over the decade. If haven’t been working on or talking icaid. They are doing very well. bundled payments were expanded be- about or wrestling with in committee, According to CBO, the gross cost of yond post-acute care and even half of out of committee, in hearings, in the the managers’ amendment is, over the the potential savings from bundled public debate for over a year now. If next 10 years, $871 billion—less than payments were realized in the Medi- the minority had taken a little less the $1 trillion we started with in our care program during the upcoming dec- time to have press conferences and committee. But it buys a lot. I will ade, these savings would translate to spending their time doing news con- talk at some time, perhaps tomorrow an additional 0.2 percent per year re- ferences denouncing what they hadn’t or afterward, about what this bill pro- duction in program expenditures, or analyzed, they would have a better vides in addition. But I think it is crit- more than $190 billion between 2010 and sense they might have been able to ical for people to follow the truth, to 2019. read the managers’ amendment on the look for the facts, and to measure the Similarly large reductions in Federal Internet for over a month—excuse me, reality of the positive ways in which health care expenditures are plausible the managers’ amendment was on the this legislation will provide additional from the combination of other delivery Internet on Saturday, and many of us help to seniors, will reduce premiums system reforms, including: Account- looked at it, because many of us have for many Americans, will help people able care organizations, incentives to worked on provisions and we wanted to afford coverage who do not have it reduce hospital-acquired infections, make sure they were in there. It wasn’t today, will spread risks throughout the health information technology adop- hard to read it to see what was and system more effectively, will improve tion, and administrative simplification wasn’t included in it. In addition, the care and delivery within the hospitals, that would standardize and streamline underlying bill has been posted on the will prevent people from being denied insurance paperwork. This will help Web for over 1 month. insurance if they have a preexisting cut down on the $23–$31 billion time But the fact is the minority has condition, will prevent them from cost to medical practices of interacting made a fundamental political calcula- being kicked off insurance they paid with health plans and their administra- tion here. They do not want to work for and thought they had when they tors. with us. In all the time we were in the get sick and they suddenly get that let- Another potentially significant cost Finance Committee trying to mark it ter that says: Sorry, you are not cov- saver within the Senate bill is the up, we never had people come to us—as ered anymore, and families go bank- Independent Medicare Advisory I often have here in the 25 years I have rupt—that is over. That alone is an Board—IMAB. The IMAB would rec- been here when you are legislating se- enormous step forward for this coun- ommend changes to the Medicare pro- riously—and say, hey, if you include try. gram that would both improve the this or if you work this a little or if CBO has underestimated savings be- quality of care and also reduce the you tweak this, I think I could support fore. growth rate of program spending. The this bill. There is just a fundamental According to the Generic Pharma- CBO score of the Senate bill estimates political divide, a fundamental philo- ceutical Association . . . ‘‘In 1984, it that the IMAB would reduce Medicare sophical divide. We are looking at a was predicted that the Hatch-Waxman spending by $23 billion from 2015 to party whose opposition to health care Act would save our country $1 billion 2019, with the savings likely to con- for Americans is not new. My colleague in the first decade. Now, generic medi- tinue in the subsequent decade. The from California talked about it a few cines save more than that every three IMAB has the potential to increase the minutes ago. In 1935, they tried to kill days.’’ savings from many of the delivery sys- Social Security and succeeded in pre- In the mid 1990s, the Congressional tem reforms described above, which venting health care from being in- Budget Office released an analysis may not be fully captured by the CBO cluded in the bill at that time. They showing that in 1994, the 10th anniver- estimates for the reasons previously argued in 1935 the same thing they sary of the enactment of Hatch-Wax- mentioned. argue now. man, annual savings from generics had Taken together, the combination of Madam President, may I ask how reached approximately $8 billion to $10 Medicare- and Medicaid-related provi- much time we have? billion. sions in the Senate’s Patient Protec- The PRESIDING OFFICER. The Sen- The new data released showed that tion and Affordable Care Act are esti- ator has consumed 20 minutes. by 1999—15 years after Hatch-Waxman mated to reduce the annual growth Mr. KERRY. How much time do I became law—generics were generating rate of Federal spending on both pro- have? $49 billion in annual savings. grams by 1.0 percentage point in the The PRESIDING OFFICER. The ma- In the last decade alone, generics upcoming decade and by an even great- jority has 15 minutes remaining. have saved consumers, businesses, and er amount in the subsequent decade. Mr. KERRY. And is that State and Federal Governments $734 These savings would increase national predesignated? Is the 15 minutes re- billion. savings and improve the long-run per- maining predesignated, Madam Presi- According to a December 14 report by formance of the U.S. economy. dent? the President’s Council of Economic The PRESIDING OFFICER. The Sen- The PRESIDING OFFICER. Not by Advisors: CBO’s analysis is generally ator from Connecticut is recognized. order. limited to the Federal budget, and does Mr. LIEBERMAN. Madam President, Mr. KERRY. Madam President, in not attempt to account for savings in I rise to declare and explain my sup- fairness, I was not aware; I thought I the health care system more broadly port for the Patient Protection and Af- had the full amount of time, but I do from policies implemented through re- fordable Care Act. First, I commend not. I want the Senator from Con- form. For example, the CBO found only Senator REID and all those who worked necticut to be able to share his $19 billion in Federal Government sav- so long and hard, including my friend thoughts also. Let me just say, and I ings from transitioning toward post- and colleague from Connecticut, Sen- will wrap it up here, that the insurance acute bundled payments in Medicare. ator DODD, for all they have achieved industry, which they sought to protect, However, recent research published in in this legislation. The truth is, no survived the passage of the Social Se- the New England Journal of Medicine piece of legislation, as significant and

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Are the things we like in under Medicare Part D to offer medica- borrow will be imperiled, when we will the bill greater than the things that tion therapy management services to have to raise interest rates so high it worry us? For me, the answer to both beneficiaries so they can better adhere will constrict our economy and send us these questions is yes, because this bill to their prescription treatments. All back into a recession, worse than the makes real progress on the three im- that is progress on the first goal that I one we are coming out of now. portant goals I have had, and I think and most others had, which is to re- We cannot bring the fiscal books of most people have had, for health care duce the cost of health care without our Government back into balance by reform. compromising—in fact, improving—its only making the health care system First, most of us have wanted to stop quality. more cost efficient, but we will never the continuous increases in the cost of The second goal. If this bill passes, control our national debt without health care that burden every indi- insurance companies, as Senator doing so. Medicare is in a particularly vidual, family, business, our Govern- KERRY said, will not only not be able to perilous condition today. Without re- ment, and our economy. Second, we deny coverage if an individual has a form, the Medicare trust fund will be have wanted to regulate insurance preexisting condition, they will not be broke in 8 years—broke. With tens of companies to provide better protec- allowed to rescind coverage if you be- millions of baby boomers reaching the tions for consumers and patients. come sick, which is the outrageous re- age of eligibility, we simply must pro- Third, we have wanted to find a way to ality today. Thanks to changes made tect Medicare so it remains a viable make it easier for millions of Ameri- by the managers’ amendment, insur- program for both current and future cans who cannot afford health insur- ance companies will also be required to generations. ance today to be able to buy it tomor- spend more of the premiums they col- This leads me to my firm opposition row. I believe this bill makes real lect on medical expenses for patients to the creation of a new government- progress in achieving each of these rather than on administrative costs run insurance program and to lowering three goals. Most importantly, it does and profits. That is real progress on the age of eligibility for Medicare to 55 so in a fiscally responsible way. the second goal I mentioned. years. That opposition was rooted in The Patient Protection and Afford- As for the third goal, the fact is at- my very serious concerns about our able Care Act not only does not add to tested to by the CMS Actuary and long-term national debt and the fragile our national debt, through new health CBO, 31 million more Americans will fiscal condition of Medicare. For any care delivery reforms it will help re- be able to have health insurance as a new government-run insurance pro- duce the debt by $130 billion over the result of this legislation. We say that gram, including the Medicare exten- first 10 years, according to the inde- so often I think we forget the power of sion-expansion idea, the moment pre- pendent Congressional Budget Office. it—31 million people who do not have miums do not cover costs the Federal That figure could multiply many times health insurance today will have it Government—that is Federal tax- over during the second 10 years, after this bill passes. That is a giant payers, the American people—would thanks, in part, to the managers’ step forward for our society. It is not have to pay the difference. That could amendment that incorporated stronger only the right thing to do, but it will easily put our Federal Government and cost-containment proposals that sev- also eliminate the so-called hidden tax the taxpayers on the hook for billions eral of us, across party lines, made to that each of us who has health insur- and billions of dollars in future liabil- Senator REID. ance today pays in higher premiums ities and further jeopardize the sol- In addition, it is very significant when someone who has no health insur- vency of Medicare. that, according to the Actuary at the ance gets sick and goes to the hospital Because of the insurance market re- Center for Medicare & Medicaid Serv- to be treated. That is real progress on forms in this bill and other measures— ices, this bill will extend the solvency the third fundamental goal of health the creation of a new system of tax of the Medicare trust fund for an addi- care reform that I mentioned. credits and subsidies for people making tional 9 years. This act will also take Is there anything in the bill that up to 400 percent of poverty—the cre- substantial steps toward creating a worries me? Of course, there is. I would ation of a new government-run health health care delivery system that pays say, most of all, I worry that we, and care, the so-called public option or the for the quality of the care patients re- future Congresses, will not have the expansion of Medicare to people under ceive rather than the quantity of care. discipline to keep many of the prom- 65 is not necessary. Neither proposal I am proud to have worked with Mem- ises we have made in this bill to con- would extend coverage to one person bers of both sides of the aisle to include trol costs by transforming the way who will not be benefited by the new amendments that would do that. health care is delivered because some provisions of this bill, neither the pub- For instance, Senator COLLINS and I of these reforms are controversial and lic option nor the expansion of Medi- introduced an amendment, parts of they are going to be opposed by some care. Yet both proposals would, in my which were included in the managers’ health care providers and health care opinion, lead to higher premiums for package, that will enhance trans- beneficiaries. Without the kind of dis- the 180 million people who have insur- parency for consumers so they can cipline I have just mentioned, this bill ance today and are struggling to afford make more informed decisions in will add to our national debt or in- the health insurance they have now be- choosing their health care providers crease taxes. Neither of those results is cause of cost shifting. and insurers. In fact, our amendment acceptable. If we stick to the contents According to studies by the CBO, a will create Physician Compare, a new of the bill, this bill will cut health care new government-run insurance pro- Web site where physician quality meas- costs and it will reduce our national gram, a public option, would actually ures that exist now but are not known debt. likely charge higher premiums than by the rest of us will be posted for ev- In my opinion, our exploding na- competing private plans on the ex- eryone to see and to use in the choice tional debt is the biggest domestic change, and expanding Medicare to of physicians. This will also create in- threat to our country’s future. That is cover people 55 years or older would centives, we believe, for doctors to pro- why I have said this bill must reduce lead to additional cost shifting. vide high-quality, more efficient care. that debt, not increase it. Accumulated I know the removal of the public op- I also cosponsored an amendment in- debt is currently over $12 trillion, with tion from the bill in the Senate dis- troduced by Senator WARNER and some our budget office estimating an addi- appointed and angered many Members other freshman Senators that will con- tional $9 trillion added in the next 10 of the Senate and the House, while I

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00042 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32948 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 know it pleased and reassured others. I threat to our Nation’s future. That and abstain from tobacco use, pro- wish to say to those who were not means we must begin to make politi- tecting Medicare for seniors by ensur- happy about the removal of the public cally difficult decisions to reduce our ing that any savings found in Medicare, option from this bill that I believe debt. That means saying no to some a program that is going broke, are used President Obama never said a public groups and some ideas, including some to strengthen that program, not to cre- option was essential to the reform we would otherwise support, because ate new entitlements, and helping all goals he set out to achieve and that we simply cannot afford them. Americans afford health care coverage most of us have. When the President A final hope about the conference re- by fixing the flawed Tax Code so that spoke earlier this year to the Joint port. Perhaps some will say it is naive. all Americans can get tax benefits for Session of Congress, he said a public I hope the conferees will find a way to purchasing health insurance. option is ‘‘an additional step we can produce a report that can be supported Unfortunately, the bill fails to do take.’’ An additional step, he said, but by some Republican Members of the these things. I know most Members not an essential one. Then, he added, Senate and House. It is a sad com- agree on those principles for reform. ‘‘The public option is only a means to mentary on this moment in our polit- The hard part is making the principles that end.’’ He concluded that we should ical history that so major a reform will come to life by translating them into remain ‘‘open to other ideas that ac- be adopted with no bipartisan support. bill language. I did that a few years ago complish our ultimate goal.’’ Hopefully the conference will find a when I introduced 10 steps to transform I am confident this bill accomplishes way, difficult as I know it might be, to health care. Once the bill was intro- the goal the President and most of us conclude this long legislative journey duced, I went on a tour of Wyoming in set out to achieve without the creation with a bill that is not only worth sup- March of 2008 and hosted town meet- of a brand-new government-run insur- porting, as I believe the Senate bill ings to talk about health care to my ance company or the further weak- now surely is, but also engages the sup- constituents. Some of the ideas I in- ening of Medicare. This bill, as it ap- port of Members of both parties. cluded in my 10 steps plan I also filed pears it will emerge from the Senate, is I yield the floor. as amendments to the Reid bill. We delicately balanced. I understand the Mr. ENZI. I ask unanimous consent need to end discrimination based on normal inclination in a conference that our time be extended in the same preexisting conditions. No one that has committee with our colleagues in the amount as their time was extended. at least catastrophic coverage should House is to split the difference. But The PRESIDING OFFICER. Without be denied coverage for a preexisting splitting the difference on this bill runs objection, it is so ordered. condition. Everyone should have cata- a real risk of breaking the fragile 60- Mr. ENZI. I yield myself 15 minutes. strophic coverage, but no one should be vote Senate consensus we have now The PRESIDING OFFICER. The Sen- forced to buy anything. If someone and preventing us from adopting health ator from Wyoming. does not at least have catastrophic care reform in this Congress. Mr. ENZI. Mr. President, the major- coverage, then they should have to pay That would be a very sad ending. ity has voted to cut off further amend- more if they want coverage in the fu- Rather than splitting our differences, I ments to this bill. Senator REID has ture. hope the conferees will adopt our used a procedural tool that prevents Everyone should get the choices for agreements so we can enact health care Republicans from offering amend- health care that Senators get. Senators reform this year. The rules of the Sen- ments. Several of my Democratic col- get to choose between competing pri- ate require 60 votes to end debate on a leagues have come to the floor to argue vate plans. So should all Americans. conference report. that Republicans don’t have any ideas Senators get the same choices as any The PRESIDING OFFICER. The time on how to improve the bill. Nothing other Federal employee. No more, no of the Senator has expired. could be further from the truth. Repub- less. The janitor in the building, the Mr. LIEBERMAN. I ask unanimous licans have filed over 200 separate mailman, the forest ranger, we all get consent for an additional moment, amendments. Yet the majority is refus- the same choices. All choices are from maybe 2 moments, to complete my re- ing to allow us to vote on any. On a bill private insurance. The Federal Govern- marks. that will affect the health care of every ment does not have its own plan. Like The PRESIDING OFFICER. Without American and one sixth of the Nation’s other employers, the Federal Govern- objection, it is so ordered. economy, the majority has not allowed ment does pay part of our health care, Mr. LIEBERMAN. Each Member of us to have more than 10 votes to try to but not all of it. Our choices allow us the Senate will have to decide once improve the bill. to pick a plan with a higher premium again when this bill emerges from the This bill needs to be fixed. We know at a lower deductible or a plan with a conference whether he or she wants to this bill currently will cut Medicare, lower premium and a higher deduct- be one of the 60 votes necessary to take raise taxes, and increase insurance pre- ible. Everyone should have these same up and pass the conference report. In miums. If we had the chance to offer choices, but they would have to work this case my own sense of the Senate is amendments, I believe we could make for a company willing to make a con- the same as that expressed in the last changes to fix the problems. I filed nine tribution to be personally willing to few days by Senators CONRAD, NELSON, amendments, but I have not been al- make that contribution and pay the re- and others. If significant changes are lowed to offer any. I believe any reform maining premium and deductible. made to the Senate bill in conference, should reflect the following core prin- No matter how the health care re- it will be difficult to hold the 60 votes ciples: reducing health care costs so form bill comes out, there will not be we now have. I have two priorities that that all Americans get the quality, af- free insurance. Everyone will pay will matter a lot to me. The first is to fordable care they need, ending dis- something. The amount we pay should continue and maintain the health care crimination based on preexisting con- have a relationship to the choices we reforms that will improve the cost-ef- ditions, ensuring everyone has access make. Insurance costs will only come fectiveness of our health care system to at least catastrophic care, pre- down if we are encouraged to make the and help reduce the national debt. Sec- serving the right of patients to choose best choices. ond, I hope there will be no attempt to the doctors and health insurance plans Speaking of choices, there is no rea- reinsert a so-called public option in that meet their needs, eliminating son shopping for health insurance any form in the conference report. junk lawsuits and reforming our med- should be any more complicated than That would mean I will not be able to ical liability system, reducing health purchasing an airline ticket. Everyone support the report. care costs for all Americans, improving should be able to fire up their com- I want to support it. I believe I am patient safety, encouraging incentives puter and look up health insurance op- not alone in that opinion among the 60 for healthy behaviors by allowing in- tions as they look up airline flights. who supported the bill last night. Our surers to charge low premiums to peo- Each State should set up a Web site or exploding national debt is the biggest ple who eat healthy, exercise regularly, an exchange where consumers can find

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I was able to neutralize much Washington says they have to put on insurance. of the insurance lobby. there. Every insurance company should People should be able to buy insur- By creating Small Business Health be allowed to list their plan on any ex- ance across State lines. Companies Plans, we can put small business own- change, and the State could certify should be able to sell insurance any- ers in the driver’s seat instead of the whether the plans meet the minimum where in the United States. Policies Federal Government or insurance com- requirements and whether subsidies should be listed on the State exchanges panies. Through their associations, could be used for those plans. There with a disclaimer stating the policy is small business owners will have the could also be ratings for how well the an out-of-State policy. The exchanges kind of clout in the marketplace need- company provides for its insured cus- would also say whether the policy ed to negotiate high-value and high- tomers, but people could buy from any meets minimum credible standards ac- quality health insurance for their company, having been warned. cording to Washington and the State. members on a regional or even national Everyone could use the trans- Insurance commissioners in both the basis. parencies of the exchange to find the insurance company’s State and con- Additionally, throughout the health insurance that best suits them. Trans- sumer’s State, each get their usual care debate, we have heard Democrats parency would also bring the costs amount for the sale—originators, be- say we need a public option in order to down. Another thing that will bring cause they can be consulted, and pur- keep insurers honest and to have more down cost is changing the system from chaser State, as they have to handle choices for Americans. However, the one that provides sick care to one that complaints. only place where we don’t currently provides health care. One way to do We need to help small businesses. I have competition is for the millions of this is to focus more on preventing pre- have been working on health care re- Americans who are currently trapped ventable diseases. We know that incen- form for some time. Small business in the Medicaid Program. Democrats tives to encourage changes in behavior owners are seeing their insurance pre- believe it is OK to lock 54 million poor can result in lower costs for patients miums go up and up every year. They American people into Medicaid and and employers. We know this because need real help. What they don’t need is have them languish in a system that is 70 percent of all health care costs are for the Federal Government to make broken and they are unwilling fix. driven by behaviors. If you provide in- their insurance even more expensive. Their solution is to keep adding more centives to change those behaviors, CBO says the Reid bill will drive up in- Americans to this broken system. A you have a potential decrease in cost of surance costs for small businesses. I 2007 Wall Street Journal article stated 70 percent of all of the health care have proposed a bill that CBO scored as that Medicaid beneficiaries have poorer costs for an organization. saving small businesses money by low- health than their peers with private in- Companies such as Safeway have de- ering their health insurance premiums surance. A study published in the Jour- signed plans that focus on personal re- by up to 6 percent. nal of the American College of Cardi- sponsibility and provide targeted in- Small business health plans allow ology found that Medicaid patients centives that lead to behavior changes businesses to join together through were almost 50 percent more likely to that can reduce the risk of developing their trade association across State die after coronary artery bypass sur- four of the most costly chronic condi- lines even nationwide so they can form gery than patients with private cov- tions. Safeway’s model, focused on four big enough purchasing pools to effec- erage. Merritt Hawkins found that in chronic conditions, can be attributed tively negotiate with the insurance 15 major metropolitan areas and in to 75 percent of all health care costs: companies and providers. Ohio has seven particular cities, including Cardiovascular disease, which is 80 per- enough people they were able to do this Washington, DC, Medicaid acceptance cent preventable; cancer, some types within their State. It is effective. It was below 50 percent. are 60 percent preventable; type 2 dia- brought down the cost of health care. A 2002 MedPAC report stated that 40 betes, which is 80 percent preventable; They were able to save 23 percent just percent of physicians—let me repeat and obesity. As a result, Safeway has on administrative costs. They were that: 40 percent of physicians—will not seen their health care costs remain flat sure if I could get my bill through, treat Medicaid patients because of over the past 4 years, while other em- they would save even more by going their concerns about reimbursement ployers experience annual cost in- across State borders. That is one that and the time and added cost of com- creases as high as 6.3 percent. This is a has been in the lab. It has been proven pleting the billing paperwork. Even the huge accomplishment for Safeway and to work. Not in the bill. Office of the Actuary at the Centers for its employees, and the employee satis- Small Business Health Plans, which Medicare and Medicaid Services has faction is fantastic. Senator HARKIN was S. 1955, drafted by myself and Sen- stated that providers will accept more and I had an amendment that would do ator NELSON of Nebraska, former Gov- patients with private insurance than that. It was inserted into the HELP ernor and insurance commissioner, was government-run health care due to the Committee bill and then pulled out voted out of the committee in March more attractive private physician pay- without talking to us before it was 2006. On May 2006, cloture on the bill ment rates. If you cannot see a doctor, printed in September. Never heard of was not allowed in the Senate by a you do not have insurance, no matter that being done to Senators before. vote of 55 to 43. I know how tough what the special name. Health care reform legislation should health care reform is to pass. I had a As we increase dramatically the include the necessary provisions to en- majority of the votes but not enough number of people eligible, we should sure that companies can continue to to begin debate. At the same time, Sen- find a way to offer them regular insur- provide successful prevention programs ator SNOWE was poised to do a single ance so they do not have the stigma of that lead to better health and lower amendment that would have solved the being on Medicaid. They should be able costs but also allow those programs to objection for 80 percent of those who to choose between the usual Medicaid be replicated across public and private voted against it. Without cloture, that and a private policy with a subsidy. health programs. We should encourage amendment could not be offered. The Unfortunately, the Reid bill expands these programs and allow people to Snowe amendment would have solved Medicaid, and the reason is because it reap the benefits of better health out- the question of what health plan man- is cheap. According to the Congres- comes and lower health costs. Addi- dates would be required. The desire for sional Budget Office, it costs 20 percent

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00044 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32950 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 more to cover a person in the ex- deductible size of the gift is a refund, the most productive and bipartisan change, funded by Federal dollars, than then they would not have to include a committees, with a substantial number through Medicaid, which is shared be- check. of bipartisan bills signed into law each tween Federal and State governments. On the subject of taxes, taxes have to year. One of my amendments would change be fair to everyone. Right now, big Whether it is the reauthorization of all of this. Senators and their staffs all companies can write off the health care the National Institutes of Health or have the ability to choose between they provide their employees, so those the renewal of the Ryan White and competing private plans, and I believe employees are getting health care with PEPFAR programs for people with we should give that same kind of zero income tax. Individuals who buy HIV/AIDS here and abroad, I am com- choice to low-income Americans. In- insurance pay income tax on all the mitted to working across the aisle on stead of trapping people in a broken money they use to buy insurance. That issues of importance. Working to- Medicaid Program, my amendment is not fair. gether, we got patient safety, mental would provide individuals who would I have covered just a few of the ideas health parity, and genetic non- otherwise be enrolled in Medicaid I have. I have several more ideas I have discrimination legislation over the fin- through the expansion in this bill the been talking about time and time ish line. These proposals had been right to choose to be covered by Med- again, none of which show up in the pending for years. We were also able to icaid or a qualified private health plan bill. These meet the promises that were have a strong bipartisan bill to over- offered through their State exchange. made. The bill does not meet the prom- haul the drug safety functions at the Every American should be able to ises that were made. FDA. By working together, instead of choose to enroll in private insurance, Health care is too complicated and against each other, we can achieve pas- and my amendment would provide real encompassing to be done by a single sage of many more pieces of critical choice access to a network of physi- bill. I have never worked on a bill that legislation. cians and fix this problem. It would affects 100 percent of America. Ade- Everyone agrees we need real also assure them they would have cov- quately done, rather than assigning de- changes that will allow every Amer- erage for an entire year, not just while tails to agencies, a comprehensive bill ican to purchase high-quality, afford- their income fluctuates. has to contain details. Assigning the able health insurance. Not a single one On the topic of expanding govern- tough parts to the Secretary of Health of my Senate colleagues on either side ment programs, I would also like to and Human Services makes it easier to of the aisle supports the status quo. mention that if you save money in legislate, but you don’t know what the The argument that Republicans sup- Medicare, it should only be used to final outcome will be. Done in smaller port the status quo is simply false. We help Medicare because it is already incremental steps, the bill would be understand that the current system going broke. The current bill takes more understandable. More impor- fails too many Americans. We want to money from Medicare and uses it for tantly, with the huge, more com- support reforms that will provide real other government programs. This bill prehensive bill, the more people who insurance options to all Americans and takes $466 billion from Medicare and each don’t like a particular part will help lower the cost of that insurance. But I have said from the start of this uses it to start new entitlements that defeat the whole bill over a few parts. year, and frankly throughout my 13 have nothing to do with Medicare. Yet We need to start over. We need to years in the Senate, true reform should they start a new commission to figure pursue a step by step, bipartisan, ap- be developed on a bipartisan basis, so out where to make additional Medicare proach. We need to match up a Repub- that the legislation will incorporate cuts in order to keep the system lican idea with a Democrat idea. We the best ideas from both sides and will going—doesn’t that seem counter- need to leave out a Republican idea and have the broad support of the America. productive—after limiting where the leave out a Democrat idea. Pursing That should be a prerequisite for any cuts can come from because of hidden this type of strategy, what I call the proposal that will affect the nearly 20 deals to get support for the bill. 80-percent rule, would likely mean percent of our Nation’s economy and Whatever we do has to reduce costs broad support from both sides. This the health care of every American. for all individuals and be deficit neu- would mean that the rigid ideologies of We have only had 10 votes on Repub- tral. It has to truly be paid for. Why both sides would oppose such a bill, but lican amendments. It is not because does it have to be paid for? Because I am confident that majority of the Republicans agree the status quo is ac- America is going broke. We have American people would support a bill ceptable or because we think the maxed out the credit cards, and now we like this. health care system works fantas- are driving down the value of our We need health care reform, but it tically; quite the opposite. Republican money. We have to use honest cost, not has to be done the right way. The best Members have filed 223 amendments to gimmicks such as the doc fix delay or way to reform our health care system this bill. Unfortunately the majority collecting revenues before the benefits is to do it step by step. We need to leader has blocked us from offering our kick in and showing years of revenue start by focusing on the issues where amendments. for a shorter time benefit. we already have broad, bipartisan This bill is too important to get What ways can the government pay agreement. wrong. We need the opportunity to im- for anything? Unfortunately, they can I know how to pass bipartisan legis- prove this bill, and I would urge my cut benefits, cut payments to doctors lation. Since I came to the Senate 13 colleagues in the Democrat leadership and other providers, increase taxes, or years ago, I have worked with both to allow us the opportunity to do so. cut waste, fraud, and abuse—which Democrats and Republicans to reform Madam President, I ask unanimous government seldom does and even more our Nation’s health care system. Over consent that an editorial by David seldom does effectively—or, more hon- my years in the Senate, there have Broder, ‘‘One Is the Loneliest Number estly, allow a checkoff for donations to been several times when I have worked for President Obama,’’ be printed in other people’s insurance—perhaps even across the aisle to get health care bills the RECORD. It mentions some of the a tax-free donation—so people who signed into law. editorials and key points of editorials want a bigger role in seeing that every- When I joined the Senate, the Health, that I put in my speech last night. body has insurance could directly par- Education, Labor, and Pensions Com- There being no objection, the mate- ticipate. People who argue that it is mittee was one of the more contentious rial was ordered to be printed in the imperative we extend health benefits committees. I believe that people can RECORD, as follows: to everyone should put their money agree on 80 percent of the issues 80 per- ONE IS THE LONELIEST NUMBER FOR where their mouth is. People should cent of the time and, if they leave the PRESIDENT OBAMA have an opportunity on their income other 20 percent out, they can get a lot (By David Broder) taxes to make an instantly deductible done. With that in mind, Senator Ken- In the last year or so of George W. Bush’s gift to the health care of others. If the nedy and I worked to make it one of second term, commentators used to talk a

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00045 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32951 lot about the conspicuous scarcity of other gress, given the boost he provided them in tional speeches he urges his audiences to cul- Republicans willing to stand up and defend the last election, the difficulty of the prob- tivate it: ‘‘Your relationships are the heavi- him. I never thought we’d see Barack Obama lems he inherited, and the stiff-arm he has est components of your life. The slower we face the same problem before his first year received from the Republicans. move, the faster we die. We are not swans. was over. But the reality is that, the closer the mid- We’re sharks.’’ But as Obama’s approval scores (50 percent term election comes, when they will be on The movie begins and ends with everyday in the latest Washington Post-ABC News the ballot and he will not, the more members people talking to the camera, making re- poll) sink, it is getting harder and harder to of Congress—and not just Pelosi—will judge markably sensitive statements about the find a full-throated supporter of the presi- what is best for themselves and the less trauma of being declared dispensable. Some, dent. they’ll be swayed by Obama. however, recall that the consequences in- You need go no further from here than the He may feel lonely now, but he ain’t seen cluded being reminded that things they re- op-ed page of Thursday’s Washington Post to nothing yet. tained, such as their human connections, are see what I mean. Time was, and not all that Mr. ENZI. Madam President, I also truly indispensable. The opening soundtrack is a weird version long ago, when the Post was thought of as ask unanimous consent that an edi- the ‘‘liberal paper’’ in Washington, a reliable of Woody Guthrie’s ‘‘This Land Is Your advocate for the kind of policies pursued by torial by George Will from the Wash- Land.’’ This hymn to Depression-era radi- Democratic presidents. ington Post titled ‘‘The Indispensable calism is catnip for people eager to tickle a Well, in the lead article on the op-ed page, Dispenser Opens Up’’ be printed in the political manifesto from any movie that has a well-known member of the president’s RECORD. It shows how Medicare is left a contemporary social setting. party said that Obama’s prize piece of do- up in the air after the Reid bill. But although ‘‘Up in the Air’’ might look mestic legislation, the health care reform There being no objection, the mate- like a meditation on the Great Recession, it bill, has been so compromised that as it rial was ordered to be printed in the is based on a novel published in 2001, during stands, ‘‘this bill would do more harm than the mildest recession since the Depression, RECORD, as follows: good to the future of America.’’ and written before that. ‘‘If I were a senator,’’ wrote Howard Dean, THE INDISPENSABLE DISPENSER OPENS UP You must remember: In 2006, the last full former governor of Vermont and the chair- (By George Will) year before this downturn, when the econ- man of the Democratic National Committee Ryan Bingham has a unique way of de- omy grew 2.7 percent and the unemployment during Obama’s run for the White House, ‘‘I scribing his life. rate was just 4.6 percent, 3.3 million people would not vote for the current health-care ‘‘Last year,’’ he says, ‘‘I spent 322 days on lost their jobs to the normal churning of a bill.’’ the road, which means that I had to spend 43 dynamic economy. This ‘‘creative destruc- Dean, who had been signaling his apostasy miserable days at home.’’ Home is an Omaha tion’’ has human costs, but no longer is op- for some time, was far from alone in clob- rental unit less furnished than a hotel room. tional. bering Obama, just as the president and Sen- He likes it that way. America has an aging population, and has ate leaders were struggling to line up the 60 Today he is where he feels at home, in an chosen to have a welfare state that siphons votes needed to pass the ever-changing legis- airport—glass walls and glistening steel, increasing amounts of wealth from the econ- lation. synthetic sincerity and antiseptic hospi- omy to give to the elderly. Having willed Across the Post’s prized real estate, con- tality. Today he is showing Natalie, a fero- this end, America must will the means to servative columnist George F. Will gloated cious young colleague, how an expert road it—sometimes severe economic efficiency to that the more Obama argued for the bill, the warrior deals with lines at security screen- generate revenues to finance the entitlement less the public supported it. And from across ing: culture. So ‘‘Up in the Air’’ is sobering en- the aisle, Matthew Dowd, a former Democrat Avoid, he says, getting behind travelers tertainment for a nation contemplating a who served as chief strategist for the young- with infants (‘‘I’ve never seen a stroller col- giant addition to the entitlement menu. ‘‘Up in the Air’’ is two mature themes sub- er President Bush, offered congressional lapse in less than 20 minutes’’). Or behind el- tly braided and nuanced for grown-ups. One Democrats the free advice that they would derly people (‘‘Their bodies are littered with is the sometimes shattering sense of failure, be better off themselves if the Republicans hidden metal and they never seem to appre- desperation and worthlessness that over- managed to block Obama’s bill. ciate how little time they have left on whelms middle-aged people who lose their It was left to my friend, E.J. Dionne, Jr., earth’’). Do get behind Asians: ‘‘They’re livelihoods. The other is that such shocks one of Obama’s most passionate journalistic light packers, treasure efficiency, and have a can be reminders that there is more to life advocates, to tell the Democrats that they thing for slip-on shoes.’’ than livelihoods. ought to mind their manners—and their Natalie: ‘‘That’s racist.’’ But not for Bingham. He is, in his fashion, words. The increasing flak between moderate Bingham: ‘‘I stereotype. It’s faster.’’ content. In E.M. Forster’s novel ‘‘Howards and liberal Democrats ‘‘is a recipe for polit- Played with seemingly effortless perfec- End,’’ Margaret famously exhorted, ‘‘Only ical catastrophe,’’ Dionne warned, his tone tion by the preternaturally smooth George connect!’’ Bingham would rather not. suggesting that he thinks the Democrats are Clooney, Bingham is the cool porcelain heart too far gone to heed him. of the movie ‘‘Up in the Air.’’ It is a roman- Mr. ENZI. Madam President, I yield But this wasn’t the worst I saw that day. tic comedy, although Bingham begins im- the floor and reserve the remainder of The worst came in a news report of the year- mune to romance. And the comedy is about our time. end news conference by House Speaker pain—about administering it somewhat hu- The PRESIDING OFFICER (Mrs. Nancy Pelosi. Asked how she would deal manely to people who are losing their jobs. SHAHEEN). The Senator from South with next year’s looming tests of congres- Bingham is a ‘‘termination engineer.’’ He Carolina. sional Democratic support for Obama’s deci- fires people for companies that want to Mr. DEMINT. Madam President, we sion to send 30,000 more U.S. troops into the outsource the awkward, and occasionally Afghanistan struggle, she said, ‘‘the presi- dangerous, unpleasantness of downsizing. His have heard a lot about the dent’s going to have to make his case’’ him- pitter-patter for the fired—‘‘Anybody who unsustainable mountain of government self. Reminding reporters that she had told ever built an empire, or changed the world, debt, bureaucracy, and spending the lawmakers in June, when funding was ap- sat where you are now’’—rarely consoles. Democratic majority intends to create proved for 17,000 additional troops, that it But with his surgeon’s detachment, he is in rushing their health care proposal would be the last time she would ever lobby more humane than Natalie, who says this: through this Chamber. We have also her members to back such a step, she made ‘‘This is the first step of a process that will heard a lot about how much of this it absolutely clear she felt no obligation of end with you in a new job that fulfills you. they inherited. We need to remember party loyalty to support Obama on the most I’d appreciate it if you didn’t spread the important national security decision he has news just yet. Panic doesn’t help anybody.’’ that this Congress—both Houses of made. A confident young cost-cutter from Cor- Congress—has been controlled by the The liberal legislator from San Francisco nell, her brainstorm is to fire people by Democratic Party for 3 years now. The could not have been plainer if she had added, videoconferencing. She tells one desolated President does not write legislation or ‘‘You’re on your own, buster.’’ man: spend money; the Congress does. The With this as an example from the No. 1 ‘‘Perhaps you’re underestimating the posi- only thing the Democratic majority Democrat on Capitol Hill, one has to wonder tive effect your career transition may have has inherited is its own irresponsible why liberal Democrats are so furious about on your children. Tests have shown that spending. senators such as Joe Lieberman and Ben Nel- children under moderate trauma have a son negotiating their own deals with the tendency to apply themselves academically Saturday’s release of the final Demo- White House on the health care bill. as a method of coping.’’ cratic bill only increases America’s I think Obama deserves more help than he Bingham considers his low emotional me- concern with this Congress, its shadow is getting from his fellow Democrats in Con- tabolism an achievement, and in motiva- negotiations, and our growing debt.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00046 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32952 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 Early this morning, all 60 Democrats right now. We know we are in trouble, teapot museums. There is nothing voted to force all the taxpayers of this but there is no clearly marked path to about these or many other things in country to pay for bailouts and special get us back to where we were, and it is the Constitution because they have favors for several States. Rather than plenty frightening. nothing to do with the proper role of actually taking the time to put forth In the past year alone, this Federal the Federal Government in a free soci- real health care reform proposals that Government has taken over two of our ety. But these are exactly the kinds of would increase Americans’ ability to largest automakers, our largest insur- things our government spends its time buy and own health care plans they ance companies, the largest mortgage and money on, and we do not even could really afford, this plan forces company, and hundreds of banks. It has question anymore why that is. over 15 million Americans onto yet an- bailed out Wall Street and attempted Instead, it has gotten to the point other bankrupt entitlement program, to stimulate the economy by taking $1 where if we oppose the government Medicaid. trillion out of the private sector and doing anything, we are accused of While Medicaid is a State and Fed- spending it on wasteful government being opposed to getting it done. That eral shared program, the Democratic programs. It has thrown taxpayer is patently absurd. If you really want majority saw fit for the Federal Gov- money at people to encourage them to to get something done and get it done ernment to pay 100 percent of the Med- buy new cars and houses. And it is right, the government is absolutely the icaid Program in the State of Nebraska looking at imposing massive new job- last place we should turn. under this legislation at the expense of killing taxes on businesses in the name The tea parties, townhalls, and ral- taxpayers in the other 49 States, who of reducing global warming—all in the lies affirm that the American people will now be forced not only to deal middle of a snowstorm. are rethinking the appropriate role of with the loss of their freedoms under One of the problems we have now in the government in a free society. Hope- this huge government takeover but to this country is, instead of asking if we fully, their discontent will be dem- pay for special favors in other States. should solve it, we are asking, how onstrated in the 2010 elections. Only This State bailout is not the only should we solve it? It is now considered the American people can hold our downside of the majority’s health care a sign of admirable restraint to occa- elected Federal representatives ac- proposal; there is a laundry list we sionally ask here in this Senate and in countable for fulfilling their oath of of- could go through. Just a few include this Congress, how much should we fice. In the health care debate, this that the working American taxpayers spend? And somehow we started think- means deciding exactly what role the and their employers will be taxed $500 ing that anything less than $1 trillion government should play to help people billion over the next 10 years, and the is a good deal. There is not a pothole in in the private sector find solutions, in- Congressional Budget Office has con- America that most Members of the stead of creating a monstrous new bu- firmed that nothing in this bill de- Congress do not believe should be filled reaucracy that puts the government in creases the premiums for Main Street with an earmark from the Federal Gov- charge of every decision. Americans. ernment. There is not a bridge to no- But this debate is about much more Seniors will see their Medicare bene- where, a flat tire, a skinned knee— than health care. It is a battle for the fits changed as a result of the $500 bil- there is nothing off limits for this Con- heart and soul of America. It is a lion in Medicare cuts included in this gress today. struggle between freedom and social- bill, not to mention that this bill turns This matters not just because of our ism, between free markets and a cen- a blind eye to the physician payment unsustainable debt and the huge trally planned economy, and between system that is woefully underfunded amount of money we waste; it matters ‘‘we the people’’ and an entrenched and vitally necessary to maintain the because every time we give a job to the class of elite politicians. Medicare Program and physician ac- government, we take away some con- The current debate over health care cess for seniors. It does not matter how trol people have over their own lives, reform is a symptom of a bigger prob- good the insurance is we give our sen- and we take away a little bit more of lem in Washington. But it can be the iors if they cannot find a doctor who their freedom. In return for letting catalyst for a wider debate about the will see them. government try its hand at solving a proper role of government in our lives. Another alarming part of this bill is problem, we as citizens cede our ability The same debate can lead us to a mo- it will, for the first time in decades, to try for ourselves to find a better ment when Americans finally take a force every American taxpayer to pay way. stand to return government to its prop- for abortion services. It is awkward to admit it, but my er place—and we can all start finding Frankly, after reading this bill, it colleagues in Congress have led this our way out of the woods. seems the only Americans who are not country into the woods, despite our Madam President, I yield the floor. going to be affected by the bill are oath of office. We swore to protect and The PRESIDING OFFICER. The Sen- Members of Congress, pharmaceutical defend the Constitution of the United ator from North Carolina. companies, and insurance companies. States and to bear true and faithful al- Mr. BURR. Madam President, I am Madam President, for all the mind- legiance to it. The Constitution pre- going to be joined by a number of my boggling numbers and devastating scribes a very limited role for the Fed- colleagues, so I ask unanimous consent facts we have heard about the major- eral Government. There is not a word that we be able to have a colloquy dur- ity’s government takeover of health in our oath or in the Constitution ing the remainder of our time. care, this debate is about much more about most of what we do. As we have The PRESIDING OFFICER. Without than health care. It is about how we wandered off the path of liberty, there objection, it is so ordered. find ourselves in a situation where we are few crumbs left of the Constitution Mr. BURR. Madam President, I think are debating the best way to give the in the Halls of Congress to lead us out many Members have to ask: Why are government control over another big of the woods. we here? We are here because at 1 a.m. part of our lives and our economy. There is not a word in the Constitu- this morning, there was a cloture vote In the children’s story of ‘‘Hansel and tion about the government deciding on the consideration of the Reid man- Gretel,’’ the children drop a trail of what medical test private health insur- agers’ amendment. I think it is impor- breadcrumbs as they walk through the ers should pay for, nothing about the tant that we discuss what that means. forest so they will be able to find their government deciding how much execu- It means there are going to be no more way out of the woods. But when the tives on Wall Street should earn or amendments, no opportunity for any birds eat the breadcrumbs, the children what kind of lightbulbs or cars we Senator from any State to propose a find they are lost in the dark and should buy. There is nothing about the change to the bill. At some point, we frightening woods. thousands of parochial earmarks that will have an up-or-down vote on ex- Well, lost in the woods is exactly fund local bridges to nowhere, golf actly what Senator REID has presented where we find ourselves as a country courses, bike paths, sewer plants, and to us.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00047 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32953 But here is what we do know. We are to all of the American people. But in and Medicaid, ask yourself, have we going to steal $466 billion from Medi- this case, it is not. really done something good? Chances care. We are going to take that $466 bil- Yes, there are 31 million Americans are, you will find out if we do nothing, lion away from hospitals, from hospice, who are going to have health insur- if we do nothing, we will actually save from nursing homes, from home care, ance, 15 million of whom are delegated money in the health care system. and, yes, a popular target up here—the into Medicaid, the most dysfunctional The last fact: The Chief Actuary of insurance product many Americans delivery system that exists in the Medicare said: If you pass this bill, the have chosen, 20 percent of the seniors, American health care system. cost of health care will be $1⁄4 trillion Medicare Advantage. We are going to Yes, there is, for many States, an un- more than if we did nothing. eliminate that option. So this is one funded mandate to those States be- The President talked about bending case where if you like your health care, cause after 5 years, for most States, ex- the cost curve down. We are bending you are going to lose it. cept for those who got these special that cost curve up in this bill. We are The bill that we are considering and deals, the States are going to be re- bankrupting hospitals and nursing that will be voted on later this week sponsible for some portion, an average homes. We are chasing providers from raises $519 billion in new taxes and of 10 percent of the cost of Medicaid. seeing Medicare and Medicaid patients. fees—$519 billion in new taxes. I might Let me tell you what my Governor, There are not too many things we add for my colleagues, we are taxing Governor Bev Perdue of North Caro- can point to that are great about this tanning salons at 10 percent. What in lina, said earlier: bill. That is every reason we should the hell does that have to do with The absolute dealbreaker for me as gov- start over. health care? Well, the reason it is in ernor is a Federal plan that shifts costs to I know my colleagues are here to join there is because we dropped taxing the States. in and to offer some perspectives, and I Botox. Hollywood saw this was not ad- Well, we are shifting costs to the would ask them to chime in. vantageous to have Botox taxed, so States, and she is nowhere to be found Mr. ENSIGN. Madam President, let when they dropped that, they had to now. But the people in North Carolina, me just summarize a few problems I see find something else: poor tanning sa- the taxpayers of North Carolina are in the bill, and maybe even offer a few lons, small businesses in every commu- going to continue to be charged for this suggestions about what I think we can nity across this country. We are going expansion of Medicaid when that is the do in a bipartisan fashion—kind of this to actually tax the majority of Ameri- most inefficient place for us to have step-by-step approach many of us have cans the President said he would never put these 15 million Americans who been talking about—instead of this tax: those under $200,000, the ones who were promised health care. massive government takeover of our While we do all this, according to the can’t afford to go to the beach every health care system. weekend; the ones who don’t have a Chief Actuary of the Centers for Medi- This is a—I have lost track—I think care and Medicaid Services, CMS, 20 beach house. They are going to pay a somewhere around a 2,700-page bill percent of our hospitals and nursing 10-percent tax when they go to get a with incredibly complex legal lan- homes are going to go bankrupt. They little bit of a tan. Well, when they do guage. In the 400-page amendment of- are going to go out of business because that, how far off are we from fining fered the other day, when I was sitting as the Chief Actuary said: parents because we don’t put a high there listening to the reading of it, I enough SPF on our children, or are we They would be unprofitable within the can’t tell my colleagues how many next 10 years as a result of these cuts. going to start charging when we go to times I was listening to this and I Hospitals, nursing homes, at a time the beach because we get exposure to thought: When the regulations are that our senior population is getting the Sun? That is what happens when written to that particular small part of ready to explode as the baby boomers the government becomes a more domi- the amendment, it could be incredibly hit it, we are cutting $466 billion from nant role in health care. complex with all kinds of unintended Medicare, and we are starving the in- I might add: No doctor fix, something consequences. I thought about the bur- frastructure of hospitals and nursing many of us have highlighted. In the dens on small business and the record homes and hospice and home care. bill, there was a 1-year fix. Doctors are keeping that small businesses are going to be faced with a 21-percent cut What is going to happen to the pro- viders? The Chief Actuary, again, said going to have in this bill. in their reimbursements after this next I think what is going to also happen 2 months. There was a 1-year fix to it. if we pass this plan, the result is pro- viders will be unwilling to see Medicare with small business, there is going to It didn’t do away with the problem. It be a great incentive—if you are a small didn’t fix the whole problem. But now and Medicaid patients. business owner, the complexities are so there is no 1-year fix. We have said in Today, 40 percent of providers don’t much and you can get yourself in so 60 days doctors will be on their own. see Medicaid patients. Does that mean Yes, there were some special deals— it is going to be 50 percent or 60 per- much trouble, you know what, I am the cornhusker kickback, the windfall cent or 70 percent? We are ballooning a just going to pay the fine. I will write for Nebraska. I have to admit that I system that today is having a hard a check to each one of my employees, was proud of my colleague, Senator time finding providers. To most of us but I am getting out of the health care business. I am going to let them go out JOHANNS, who came to the floor and that doesn’t make sense, but that is said: Let me assure you, the people in what the Senate is going to do. and find their own health care, whether Nebraska have never asked for some- I might also add that the attempt through the government exchanges or thing different than everybody else. was to expand coverage; and, yes, sure, whatever it is, but I am getting out. They are willing to pay their share of in numbers, we are expanding coverage. That is one of those unintended con- the way there. They haven’t asked for But, if passed, the Congressional Budg- sequences that a lot of people haven’t it to be free for them and cost every- et Office says 8 million to 9 million in- focused on. body else. dividuals who currently have em- We talked a lot about this $500 bil- Yes, it will cost my constituents in ployer-based health care will lose that lion-plus cut in Medicare. My colleague North Carolina, and it will cost the health care. Eight million to nine mil- from North Carolina mentioned that. constituents in Nevada—well, it won’t lion who currently have their health Some of the biggest places—I had two in Nevada. I think maybe there is even care will lose their health care with grandmothers who were in hospice. a deal that affects them to some de- the passage of this bill. The net-net is Hospice care is the most compassionate gree. not real pretty, and when you look at care we have today, and we are going Is it fair? No, it is not fair. The fact the $2.3 trillion that health care costs, to cut hospice care. That actually puts that it wasn’t fair was called: ‘‘That is you have to ask yourself, where is the dignity back into dying. That is just compromise.’’ beef? Where is the value in this? unconscionable. The Congressional That is not compromise. We are here As hospitals close, as nursing homes Budget Office says these cuts actually under an obligation to make this fair close, as providers don’t see Medicare will be cuts in service because you

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00048 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32954 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 can’t just take money out of the sys- share of something; my State is suf- Mr. MARKOS MOULITSAS: Yeah, I don’t tem unless you make them more effi- fering because the whole economy is in think this is a reform bill. I mean, I think cient. These cuts don’t make the sys- the doldrums and because we are such it’s very clear, this is not insurance or tem more efficient, they just take a tourist economy, construction ori- healthcare reform. What it is, it’s allowing more people, 30 million people, to buy into money out of the system, whether it is ented, the housing industry, all of the existing broken system. It’s very impor- out of hospice or nursing homes or the those things, and because the general tant to keep in mind that healthcare insur- home care, but also out of Medicare economy went down, my State is suf- ance is not the same as health care. Insur- cuts. fering. ance, not the same as care, if you go up to We know there is $120 billion in cuts So the Senator is exactly right. We Massachusetts, they have a mandate as well, to Medicare Advantage. The Congres- should be looking at what is best for and last year 21 percent of people in Massa- sional Budget Office said by 2016, 64 the entire country. As John F. Ken- chusetts could not get health care because percent of the extra benefits, whether nedy said: A rising tide raises all boats. they could not afford it. Even though they had insurance, the premiums—not the pre- those are prescription drugs or dental Well, if the whole country is doing bet- miums, the deductibles, copays and out-of- coverage or vision coverage, the sen- ter, whether it is on health care or pocket expenses were too high. So really, iors covered under Medicare Advantage whatever it is, instead of looking for this isn’t reform. It’s expanding the system, are going to be cut 64 percent because something individual for our States, it’s almost rewarding the existing system. of this legislation. you are exactly right. I think our indi- Now, what is important about this is that it We also know there is around $500 vidual States will do better if the actually puts the federal government, plus billion in new taxes, and this is a com- whole country does well. America on the place to say health care is a plete violation of the President’s prom- Mr. COBURN. Madam President, I right, it’s not a privilege to just those who ise during the campaign when he said ask unanimous consent to have printed are—who can afford it or who are lucky enough to have a good job that has good ben- not one dime in new taxes will be in the RECORD an article that appeared efits. But as far as reform goes, I think this raised on those individuals making less today. It is a quotation from the found- is a long battle that we have ahead of us. than $200,000 or families making less er from the Daily Kos Web site. I will Mr. MOULITSAS: Well, you can’t talk about than $250,000. Yet in this bill, of the give it to the clerk in a moment. I wish health care and Afghanistan being distrac- $500 billion, 84 percent is paid by those to read a quote from it: tions. They’re the reasons that Obama won people the President said wouldn’t I don’t think this is a reform bill. I mean, the White House and Democrats won control have their taxes raised by one dime. I think it is very clear this is not insurance of Congress, including big, massive support We also know, because the Senator or health care reform. What it is is allowing from independents. Independents know what they were voting for when they voted for from North Carolina talked about it, more people, 30 million people, to buy into an existing broken system. It is very impor- Obama and the Democrats. I think the prob- this massive Medicaid expansion—I lem with Obama’s numbers and, and Con- think it was the Democratic Governor tant to keep in mind that health insurance is not the same as health care. If you go up to gress’ numbers is that people voted for a from Tennessee who said it was the Massachusetts, they have a mandate as well. Congress and a president that was going to mother of all unfunded mandates. Well, Last year, in Massachusetts, 21 percent of take on entrenched interests. Now, Repub- we have to look at this one way. If the the people who are insured could not get licans had jumped off the Obama bandwagon sweetheart deal that was made by the health care because they could not afford it. from day one. They were never on board. Senator from Nebraska—and, by the Independents have sort of been unhappy be- That is somebody who is very well re- cause I think independents really want re- way, I agree with you. Senator spected on the majority side, and it is sults, and we haven’t seen a lot of results. JOHANNS, who came to the floor, it something we have been saying, and We’ve seen a log of bickering, and most of it takes a lot of courage to say it isn’t they are saying the same thing. The has been internally within the Democratic about just helping my State; it is fact is, what we are going to do is put Party, and I think that’s why they’re turn- about thinking about the whole coun- 15 million people into Medicaid that we ing off. And a lot of Democrats are becoming try as well. He isn’t asking for some- know has worse outcomes, we know is disenchanted. thing—which most Senators do around Mr. GREGORY: . . . What does the president an unfunded mandate on the States, need to address to keep his own party in here, ask for something just special for and we know 40 percent of the doctors line? Should there be personnel changes in the State that the rest of the States refuse to see them. So you are not the White House? What do you think the left have to pay for—but he stood up with going to get to choose the doctor you is going to demand? courage, and I think he deserves a lot want to see. You are going to have Mr. MOULITSAS: Well, 2006 is going to be a of credit for that. State mandates in terms of what is base year. It’s going to be a base election. But if all the other States now come available to you and what is not. So we MR. GREGORY: 2010, you mean. back and say: We want the Federal have violated two of the key promises Mr. COBURN. Madam President, I Government to pay for our States and with which to reform health care. wish to also quote from what I think is Medicaid, this bill is going to do one There being no objection, the mate- a brilliant letter by a Dr. Robert Geist thing. It is either going to be a massive rial was ordered to be printed in the from St. Paul, MN, that was written as unfunded mandate on our States or RECORD, as follows: a letter to the editor in the Wall Street this bill is going to massively balloon MOULITSAS: WE’LL GET KILLED IN 2010 Journal today. The title of his letter to the Federal debt. Markos Moulitsas, founder of the Daily the editor is, ‘‘The First Cost Con- Mr. COBURN. Madam President, I Kos and an influential leader of the Web- troller Will Be Your Own Doctor.’’ It is have a question for both the Senator based political left, said Sunday that Demo- something I have been talking about from North Carolina and the Senator crats are facing huge defeats in the 2010 elec- since we started this. The last thing we from Nevada. Can the State of Nevada tions because the Obama administration has want to do in health care in America is or the State of North Carolina or the alienated the Democratic Party’s liberal po- to make it where the doctor is not a State of Nebraska or the State of Okla- litical base with its escalating involvement 100-percent advocate for the patient’s homa be healthy if our country doesn’t in Afghanistan, and its failure to push for best interest. universal healthcare. flourish? So no matter what we do for Speaking on NBC’s ‘‘Meet the Press,’’ He quotes very directly the transfer. our own States, if, in fact, we are not Moulitsas offered a bleak scenario for House He said a previous article written: thinking about the country as a whole, and Senate races next year. . . . doesn’t emphasize a potential stealth the best right thing for the country as Excerpts: cost-control aspect proposed in the bill. It a whole, none of our States can flour- Mr. GREGORY: Markos Moulitsas, I want to will start pilot programs that would transfer ish. start with you. You heard David Axelrod say the gatekeeper role to doctors at the bedside, Mr. ENSIGN. I think the Senator this in keeping with the president’s prin- a role currently held by ‘‘payers’’ (HMOs and ciples; it is in keeping, the compromise on government-agency insurers, including Medi- from Oklahoma has made a wonderful health care, with the way the president cam- care and Medicaid). point. Right now, my State is suffering paigned on this. And this is the bill, essen- The transfer will be via capitation fee pay- terribly, not because of anything indi- tially, the reform that Americans deserve. ments, making clinics ‘‘responsible’’ for the vidually, such as we didn’t get our fair What do you say? cost of care of ‘‘insured lives’’ for one year.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00049 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32955 . . . The illusion of many pundits and policy up an advisory panel that if we exceed reform. The Congressional Budget Of- makers is that mini provider gatekeepers the costs we have designated for health fice said that would save $100 billion. can control costs after the very powerful care, they are going to cut the scope of The bottom line is, what we have payer gatekeepers— coverage or the reimbursement. So ei- been focused on—and I appreciate the That is, Medicare, Medicaid, and the ther the array of coverage for a senior efforts Senator BURR and Senator large insurance companies— or for an American is ‘‘skinnied down’’ COBURN made in their bill last year—is have failed for decades. The problem for pa- or we cut the reimbursement to the trying to address the No. 1 problem we tients is the dilemma of all managed-care doctor or the hospital, and they call have in health care in the United gatekeepers: cost, quality, access; pick any States, which is costs. This bill does two. It is not pleasant to think that one’s that reform. What Dr. COBURN and I found out, as not address costs. gatekeeper doctor will have to decide wheth- As a matter of fact, you said it in er to order surgery for your painful [worn many other Members have, is if you out] hip or only to increase the dose of— look at the successful companies across your opening remarks. Total health care costs actually, according to Presi- Anti-inflammatories because they this country that have held down their dent Obama’s CMS, go up $234 billion if are worried about costs. health care costs through doing real re- That is the key point. We are going form—paying for prevention and nothing is done. If nothing is done, we actually save money on total health to now separate physicians in this wellness in work, changing the life- care spending. But with this bill, it ac- country for doing what is best for the styles of the employees—we saw com- tually goes up by $234 billion. patient to meet the demands of the panies that, for 4 years, had a 45-per- cent increase in their health care. Mr. COBURN. What we also know government. from the Congressional Budget Office Mr. ENSIGN. If the Senator will Where is any of that in this bill? Out of is that between 9 and 10 million people yield. 2,700-plus pages, there is no attempt to Mr. COBURN. I will be happy to do that. There is no attempt to try to who today have insurance through their employer will actually lose it. yield. affect the lifestyles through supporting Mr. ENSIGN. As a practicing physi- chronic disease management, preven- They are going to lose their insurance. cian, isn’t this what the Senator saw in tion, and wellness, but we set up a lot That may be good or bad for them. But his practice with HMOs? of independent advisory boards. if you look at the incentives, the sub- Mr. COBURN. That is exactly why I As a matter of fact, they were so sidy for people who do not get insur- am not a member of any HMOs. scared that in the managers’ amend- ance through their employer, if you Mr. ENSIGN. Because we have kind ment, it is no longer called the Medi- make $42,000 a year, today with your of an insurance center system today, to care independent advisory board. It is health insurance through your em- a large degree, and now we are going to called the independent advisory board. ployer you get a benefit of about $5,749 make that worse. Instead of going So the word ‘‘Medicare’’ was dropped, from the tax system. But under this more toward a patient center, we are not to signify that they are going to bill, you will be eligible for $12,500 going to go from an insurance center to cut Medicare, but that is exactly what worth of subsidy. What do you think an employer is a government center to where these CBO and CMS have said. These will going to do? They are going to look at government bureaucrats now start kick in. The question is, Are they sus- their employees and they are going to being in control of eventually what tainable or will Congress legislatively say: I have to pay this penalty if I kind of care you are going to get, what override their authority to cut the don’t offer this, but it is a significantly is paid for, and all that. We need to put spending? smaller amount than what I am paying the doctor and the patient back at the Mr. ENSIGN. If my friend will yield, today. Therefore, I am going to make a center of our health care system. there is one part—actually one of the decision to no longer offer health in- Mr. COBURN. Let me finish this for a best parts in this bill—but there are so surance, give my employees a small minute, if I might. Here is the summa- many other bad parts of this bill and raise because the government is going rizing paragraph: the Senator from North Carolina men- to come in with $12,500 worth of sub- The economic reality is that no rationing tioned them, and we have talked about sidies to put them in a ‘‘private’’ plan of care supply will ever control costs, when a lot of them. The one place they actu- the problem is demand inflation driven by inside the parameters of what is in the ally have improved our health care sys- exchange. How many people do you popular insurance tax subsidies too sacred to tem is the part that allows people to repeal. Consider that when federal fiscal ‘‘ne- think it is going to shift? cessity’’ overwhelms empty slogans,— have larger discounts for healthier be- What we are going to get is adverse haviors. Safeway was the model for Our empty slogans— selection. So the individual—let’s say I this. They have done the most work on am working and I am making $42,000 a scores of new bureaucracies created in [this this in the last 4 years. Today, they bill] would be able to implement Draconian year and my employer decides to do rationing in collusion with subservient in- can discount up to 20 percent of their that and let’s say I am 35 years old and surance and ‘‘provider’’ corporations. The health care premiums for people who I know available to me is $12,500. Even high costs, as well as the rationing powers engage in healthier behaviors—for not though my earnings may go up, I am included in the more than 2,000 pages of the smoking, for being the proper body still 21⁄2 times better off. ObamaCare Senate legislation are very real. weight compared to their height, doing I also know I will have to pay $3,000 Which is the point I have been mak- things such as that. If they are a non- or $4,000 of my own money to get that ing all along. I am going to spend 30 smoker, they get a lower premium, and benefit. I will not cover myself because minutes tomorrow talking about the if they even quit smoking, Safeway I know I can cover my little rationing aspects of what we are about pays for the cessation products. To be incidentals. If I get sick, they have to to do as we pass this bill. fair, that is in the bill. Senator CARPER cover me in the exchange. Mr. BURR. If I can comment to my and I got that in the Finance Com- So we are going to see adverse selec- good friend, who started on a quest mittee. We were able to get that tion in the insurance market, people with me several years ago to try to put amendment drafted. who are between 40 and 64 who are sick together a health care reform bill, I The problem is, that is a tiny part of are going to pay far more for their might say it was the first one intro- this bill. That should be a major focus health insurance and people who are duced in the Congress in May of this of the bill. We should be able to buy in- sick who are younger than 40 are going year on comprehensive health care re- surance across State lines. Many of us to pay far more for their health insur- form—not that it is better than any- have supported that—small business ance and everybody who is healthy body else’s, but I can honestly say health plans, where small businesses under 40 is going to say: This is an eco- today it was true reform. I think that can join together and take advantage nomic bonanza for me. I am not going is what Dr. COBURN is trying to say. of purchasing power. We all, on this to buy insurance. In this bill, it lacks reform. What do side, almost everybody on this side of Mr. ENSIGN. I see our friend from I mean by that? Their reform is to set the aisle agrees with medical liability South Carolina has joined us. He has

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The cam- special deals in this bill are not spe- not honest with the American people paign in 2008 was about change we cial. They are the same old crap we about how we account for things, and could believe in. I do believe one of the have been putting up with for decades this bill is another example of that. reasons President Obama won is be- up here and that people thought was Let me give you the quantifications. cause he convinced young people in going to come to an end. It is going to If you read the CBO report on this this country that if he got to be Presi- hurt your children’s ability to have bill, they talk about it is highly un- dent, this country was going to change half of what you have because they likely we will ever actually make the for the better; we were going to do cannot make it because you are about Medicare cuts, because they have never things differently, and that resonated to pass on a bill to them they cannot seen it done, and every time we have with people. pay. said it in the past, we haven’t done it, Quite frankly, when we were in What I hope will happen, I say to my like the sustainable growth rate for- charge, as Republicans, we let people good friend, the Senator from Nevada, mula in the Balanced Budget Act of down. We let things get out of control is that the people will take their gov- 1997. So if you match up revenues and on our watch. Some of our people ernment back. If you think this deal expenses, what you see is a $1 trillion wound up going to jail. The Iraq war from Nebraska is unacceptable, speak tax increase, a $1 trillion cut in Medi- was not popular. So you had this new, up and speak out and let the House care, and an increasing cost to the young, exciting, articulate figure come Members know you want it changed. economy. along and promise a new way of doing Mr. BURR. I thank our colleague But because there is not the sustain- business. That is what hurts so much from South Carolina. I know we are able growth rate—the doctor fix in the about this bill. The special deals the about to run out of time, but I wanted bill—that is $247 billion not accounted Senator just mentioned remind us all to go back to the Chief Actuary at for, and that is if you keep physician why Congress is in such low standing. Medicare because I think the way they wages frozen over the next 10 years. The 60th vote—how did they get it? analyzed the bill is absolutely essential That is $247 billion, probably closer to Did they negotiate the 60th vote on C– for the American people to understand $300 billion. So that is $300 billion. The SPAN in a transparent manner prom- what is in it. fact is we know the taxes that are ised in the campaign that we would The Chief Actuary, the President’s going to be collected, people are going have negotiations on C–SPAN so that Actuary, said: to pull down the cost, which is one of you, the American people, could watch The Reid bill funds $930 billion in new their hopes, and they are going to pay what was being given and what was spending by relying on Medicare payment for it out of their pocket. being taken and there will be no more cuts which are unlikely to be sustainable on So we are going to see that insurance backroom deals? a permanent basis. plans not reach the Cadillac level, and Here is what happened. They took It gets to what Dr. COBURN said. By we are counting on revenues from that one Senator who was the key guy and design, maybe this could work, but in terms of billions and billions and they put him in a room. We had no ac- there is not a will because there is not billions of dollars. But what they will cess to that room and no Democrat did reform. We have spent a lot of money, do is change the deductibles—and that either. After it is all said and done, and at the end of the day, it looks as if is a hidden tax. Because if your deduct- here is what resulted from those nego- the only thing we have done is tried to ible goes up to keep your insurance tiations that were not on C–SPAN. address waste, fraud, and abuse. For from going too high, your tax goes up Nebraska is going to be the only $2.3 trillion, it seems as if you could in actual expenditures. So your ability State in the Union, ladies and gentle- bring more bacon to the table. It seems to invest and create additional jobs—in men, that new Medicaid enrollees will as if there would be a little more meat. other words, it cascades. The honest be covered by the Federal Government. It seems as if there would be some accounting for this is that there is no Every other State in the Union, when substance there we could look at and way this saves any money. It will cost you sign up a new person on Medicaid, say: Look at the improvements our money. because you are expanding the number health care system makes. The final point I will make is they of people eligible for Medicaid, your I know Dr. COBURN has said many won’t put forward the cuts in Medicare State is going to have to make a times: If we do this wrong, what we do that they are claiming in this bill. Be- matching contribution. is we chase innovation out of this cause they know if they truly do put In my State of South Carolina, with country, out of our system, the break- forth the cuts, and patients feel it, 12 percent unemployment, there is throughs that go from maintenance to they won’t be back here. So it won’t going to be one-half million more peo- cure, the research on a bench that finds happen. ple eligible for Medicaid under this bill us new ways to address diabetes where I will go back to what Senator BURR than exists today. It will cost my State amputation and blindness are not in started this out with. If you are going of South Carolina $1 billion. But if you somebody’s future. If we go backward, to start tomorrow and fix health care, live in Nebraska, it doesn’t cost you a if we chase that innovation out, we what would you do? You would attack damn dime because that is what it lock ourselves into not only the most costs. Why are things so costly? One is took to get a vote. costly health care but health care that because there is no transparency in If that is change we can believe in, achieves the least amount of quality markets. There is no real connected- count me out. If that is OK with the for future generations. ness to your pocket. No. 3, there is no American people, I can tell you our Mr. ENSIGN. I wish to ask Senator incentive for prevention of chronic dis- best days are behind us. The insurance COBURN to address, in the last couple of ease or the management of it. In other companies in Nebraska got a deal that minutes here—because he has spoken words, we don’t pay people to have less no other insurance company in the Na- so eloquently about debt and the Con- expensive outcomes. We won’t tion got. Physician-owned hospitals in gressional Budget Office saying this incentivize better care in that way. We Nebraska got a deal that nobody else helps the deficit by some $100 billion— won’t incentivize prevention. got. Louisiana got $300 million to help how the taxes go into effect right away We have done a lot of this on Medi- with their Medicaid problems that no- and that the spending doesn’t go into care—and I will talk about it tomor- body else got. effect, and how that kind of smoke and row—but they have three different

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00051 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32957 agencies within this bill that are going having on historic health care reform, over of health care, and make Ameri- to ration care. They are going to make and I am reminded of the words of a cans fear it. Well, we say: Let’s make the decisions for you, and not just on great Republican, President Abraham sure the Bernie Madoffs of the world, Medicare and Medicaid. Everybody Lincoln. He said: and people like him, are not selling needs to understand that. It doesn’t We cannot escape history. The fiery trial health insurance. just apply to Medicare and Medicaid, it through which we pass will light us down in They wave the flag, stand up the un- applies to your choice of your private honor or dishonor of the latest generation. American straw man, saying the bill is insurance. The government is going to The occasion is piled high with difficulty and against old-fashioned American values ration your care. we must rise with the occasion. and denounce it. We say: Don’t you We know that is true because they That is what Abraham Lincoln said. dare question our patriotism. Do not wouldn’t allow an amendment to pro- It is time to rise to the occasion be- dare question our commitment to hibit rationing. They all voted against cause our friends on the other side of doing what is right for the American the amendments in committees when the aisle have chosen to sit on their people. we offered amendments to limit ration- hands and do nothing. They have no They stand up the death panel straw ing. So we know the intention is to ra- plan. They have chosen to delay and man, claiming the legislation would tion care. If that is how we are going to obfuscate. kill grandma, and denounce it as inhu- control costs, then Bernie Sanders is If you look back in history, during mane. We say: Stop the outrageous right—go to a single-payer, govern- the great debates on Social Security in misinformation and tell the truth to ment-run system. Bernie Sanders’ sys- 1935 and Medicare in 1965, our friends the American people. tem is far better than this one—far bet- across the aisle were on the wrong side They stand up the taxing straw man, ter than this one—if that is what we of history. But in the end, there was a and say health care reform will in- are going to do. If we are going to ra- minority that chose to stand up for crease taxes. We say: We are making tion care, let everybody know it up- historic social legislation and vote health care entities, such as insurance front. Let’s be absolutely honest about their conscience. They were not driven companies, pay their fair share. it. by the far rightwing of their party or They set up the spending straw man, If you are 75 years of age and need a by radio talk show hosts who demand and say the bill will indebt the next hip replacement but the quality of ideological purity and see any attempt generation, despite Congressional your life is not all that great, we are to support health care reform as an Budget Office estimates to the con- going to say you can’t have it. That is abandonment of principle. trary. We say: You can’t pick and what we are going to do, because that Each of us is rarely called to act on choose when to believe the Congres- is exactly what they do in England. such significant legislation, and when sional Budget Office and stand by their They have the National Institute of we are, it is our solemn duty to put numbers only when it is convenient to Comparative Effectiveness which aside our idealogy—turn off Rush your cause. makes an evaluation of what your Limbaugh—and leave politics in the For instance, my friend Senator worth is. And no matter what your his- cloakroom. Our vote on this ground- GREGG, the ranking member on the tory, no matter what your family situ- breaking legislation—comparable to Budget Committee, touts CBO numbers ation, no matter your income, you Social Security and Medicare—will be even on his specific bill, when they can’t have it. one of the most significant votes in benefit his arguments, for example, on Canada is getting around that, be- American history. It should not be malpractice provisions. But now my cause they have said you get the right driven by the hope of failure that the friends on the other side conveniently to buy what you want. Their Supreme other side prays for, rather by the will dismiss the Congressional Budget Of- 1 Court ruled on that 2 ⁄2 years ago. So to succeed for the American people. fice numbers showing our health care we are seeing a two-tiered system de- This Congress will be remembered for plan reduces the deficit. So you can’t veloping in Canada, which ultimately this vote for generations to come, and have it both ways. will happen in this country—worse our friends across the aisle will once They bring along their partisan than what we have today. again be on the wrong side of history. straw man, accusing us of drafting a Mr. ENSIGN. If the Senator will We have heard the same tired argu- bill or having votes in the middle of yield, though, if America does this ments over and over. We heard those the night. We say: How quickly you with our health care system, where arguments in 1935 against Social Secu- forget the 4 months that we waited for will the Canadians come for their rity. We heard them again in 1965 Republicans in the bipartisan Gang of health care when they need it? When against Medicare—the same arguments 6, three Democratic Members, three they get it rationed up there, they usu- we hear today. History has a way of re- Republican Members, working, sup- ally come to the United States. peating itself. If past is prologue, his- posedly, to achieve a bipartisan effort Mr. COBURN. They will go to Thai- toric health care reform legislation in health care reform. Four months. land or India. Mr. ENSIGN. But where will Ameri- will be signed into law despite the Four months we waited for them to cans go? naysayers, the fearmongers, the pan- work with us in a constructive way, Mr. COBURN. I thank the Senator for derers to those who see any attempt at and then they all walked away. So holding this colloquy, and I will make compromise as defeat. don’t come back now and say you had one final point before I stop. To our friends on the other side, this no input in the process when you chose I don’t doubt the motivation of our is no longer about legislating, it is sim- that course. colleagues on the other side of the ply about obstructing. It is no longer And, by the way, these votes that aisle. They want us to fix this prob- about doing what is right for the Amer- take place at the time they take place lem—the problem in health care. But ican people but about stopping us from are because the Republicans insist on the problem is cost. If you don’t fix doing anything. It is not about finding stopping the process and delaying it cost, and you expand the same broken common ground but drawing lines in and drawing it out. So under the proce- system, you haven’t fixed anything. the sand. dures, once we start the process to fin- You have added to the cost. My friends on the other side have set ish that delay, it ends up at certain Mr. BURR. I thank the good doctor, up an army of straw men, as they did hours—30 hours each time from the and I thank the Presiding Officer, and on Social Security and Medicare, ma- moment we file a motion to say that is I yield the floor. nipulating the facts to create the illu- enough of the delay, let us move for- The PRESIDING OFFICER (Mr. sion of refuting the false claims they ward. Whenever those 30 hours end, MERKLEY). The Senator from New Jer- created in an attempt to score political that is when we have to have the vote. sey is recognized. points. But they could consent to have that Mr. MENENDEZ. Mr. President, I They stand up the socialist straw vote in the fullness of the day and rise to speak to the great debate we are man, call the bill a government take- light. But no, they want to have the

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00052 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32958 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 vote as late as possible, hoping that 60 John Taber, another member of the those words of the past as they relate Members who want to see progress on New York delegation, a Republican, to their health care today? More straw this reform don’t come to this Chamber raised the antibusiness straw man, say- men, more fear, more naysaying—all of and, therefore, cannot stop the fili- ing: it wrong then, all of it wrong now. buster. They want failure, and then Never in the history of the world has any They said bureaucrats would come they clamor about the time these votes measure been brought here so insidiously de- between doctors and patients. They are take place. signed as to prevent business recovery, to en- wrong. That is why it is interesting to Straw man after straw man. They slave workers. see that today the American Medical have done nothing but block this legis- In this Chamber, in the Senate, Sen- Association, the Nation’s doctors—the lation, as they have throughout the ator Daniel Hastings of Delaware, a Re- people who take care of you when you year on other legislation. They will do publican, raised the death-of-a-nation are ill, the ones who follow your anything, say anything to delay, deny, straw man, saying that Social Security progress when you have, maybe, a de- and defeat health care reform. would ‘‘end the progress of a great bilitating disease or a lifetime health They are on the wrong side of history country.’’ challenge, your doctor, the voice of now, as they were in 1935 and 1965. But In this debate we have seen the same your doctor, not any Members of the the difference between 1935 and Social army of straw men standing against us. Senate, the voice of your doctor in sup- Security and 1965 and Medicare and They have claimed that health care re- port of this historic reform—said: today is that when the debates ended form is a government takeover that This is a time of great opportunity for the in 1935 and 1965, when the legislation will threaten the integrity of our insti- American health care system. We have the was weighed on its merits, there were tutions, when in fact we create an ex- chance to substantially expand health insur- those few Republicans who voted their change of private insurance companies ance coverage, implement insurance market conscience, those who did not march in that people will be able to pursue. reforms that promote greater choice, afford- lockstep to the demands of rightwing They say it will ‘‘pull down the pil- ability and security, improve [this is the talk show hosts or in fear of tea party doctors speaking] the quality of the care and lars of the temple on our descendants’’ help Americans live longer, healthier, anarchists. and leave them in debt, that it will In 1935 and 1965, there were a few on happier and more productive lives. To that drive private health insurers out of the other side, a few who voted for So- end [the doctors of the nation say] we urge business and put a bureaucrat between all Senators to support passage of the Pa- cial Security and Medicare because doctors and patients. tient Protection and Affordable Care Act as they knew it was right for America. We already have bureaucrats between amended. But in 2009 it appears there will be no doctors and patients. They are health This is the Nation’s doctors. This is votes for health care reform—not one, insurance company bureaucrats be- your doctor who is telling the Members not a single vote from the other side of tween doctors and patients. The dif- of the Senate: Vote for it. They do not the aisle. ference is when the debate ended on So- believe the line that bureaucrats are The ideological differences were as cial Security in 1935, when the shouts going to come between doctors and pa- intense then as they are now but pure of socialism and un-Americanism had tients. They are wrong, those who are obstinate ideology did not prevail then faded, a few, a minority on the other saying that. as it will in this Chamber when we side, had the political courage to cross They called Medicare unpatriotic and vote. Before Social Security was de- the line and vote yes. un-American. They were wrong again. bated, President Roosevelt laid out the But there will not be a single vote They said it would mean the rationing changes in society and the reasons why from the Republicans in favor of this of health care. They were wrong. They we needed Social Security legislation bill, not a single vote. Our colleagues made the same argument they have before the Congress. He said then: on the other side want nothing more been making for 74 years, and they are Security was attained in the early days still wrong. through the interdependence of members of than to stop this bill, period, pure and simple. It is their intention to stand en In 1965, the champion of my conserv- families upon each other and of the families ative friends, Ronald Reagan, issued a within a small community upon each other. bloc for insurance companies and ... against any health reform that would 19-minute-long LP, for those of us who The complexities of great communities and protect American families from losing still remember that, a long-playing of organized industry make less real the sim- everything if they get sick. Their plan vinyl recording at the time. It is past— ple means of security. Therefore, we are is just to say no; and once again they gone. They are like antiques now. But compelled to employ the active interests of it was entitled ‘‘Ronald Reagan Speaks the nation as a whole, through government, will squarely be on the wrong side of history. Out Against Socialized Medicine.’’ in order to encourage a greater security for It featured an impassioned 2,000-word each individual who composes it. When President Kennedy and later Lyndon Johnson fought for Medicare, speech intended to get people to write That is what he said about Social Se- to their Congressman against the idea curity. That is why we needed Social those on the other side raised the same army of straw men they raised 30 years of Medicare that was beginning to Security and why we realize today that make its way through the Congress. without Social Security more than half earlier. They played the same game they are playing again now. Senator That was 1965. It was referred to as Op- of our seniors in this country would be eration Coffee Cup, something of a pre- living in poverty—more than half—if Curtis of Nebraska at that time voiced opposition in this Chamber saying, cursor to today’s tea parties. In his the voices then in opposition had suc- record message, Ronald Reagan said: ceeded. ‘‘Medicare is not needed.’’ He was a Re- Then the debate began. There is no publican Senator of the time, Mr. Cur- One of the traditional methods of imposing tis of Nebraska, who said: socialism on people has been by way of medi- mention of death panels but there were cine. . . . those Republicans who raised similar [Medicare] is not needed. It is socialism. It Does it sound familiar, in the year straw men to the voices we hear today. moves the country in a direction which is 2009, in the debates we have heard here A member of the New York delegation, not good for anyone, whether they be young or old. It charts a course from which there on the floor? When he became Presi- a Republican, Daniel Reed said: will be no turning back. It is not only social- dent, one of the pillars of his health The lash of the dictator will be felt, and 25 ism, it is brazen socialism. million Americans will for the first time policy was cutting benefits, in par- submit themselves to a fingerprint test. In the other body, Congressman Hall ticular through increased cost sharing Another said: of Missouri called it ‘‘an ill-conceived for Medicare and Medicaid recipients. adventure in government medicine.’’ He was wrong then, just as our conserv- The bill . . . invites the entrance into the political field of a power so vast, so powerful Those were the Republican voices of ative friends are wrong now. as to threaten the integrity of our institu- the past on Medicare. What senior in In the face of yet another landmark tions and pull the pillars of the temple down this country today—which one of our piece of legislation, is it possible there upon the heads of our descendants. parents or grandparents—believes is not one of my friends on the other

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00053 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32959 side who does not in their heart believe able to find affordable health insurance enjoy yourselves. It is inconceivable to we need to pass this legislation for the in the marketplace? The health of our me that when all is said and done, good of the American people, regard- families is not a commodity. It is not a when our differences have been aired less of ideology? Is there not one of my privilege for the wealthy. It is some- and debate has ended, that not one of friends on the other side who will vote thing everyone should be able to be my colleagues on the other side will yes to help Americans who have lost protected from without going broke. see the historic nature of this legisla- their jobs and their health care and Under this legislation, 1.3 million tion. We can be proud of this legisla- stand to lose everything if they or a seniors in my home State will be eligi- tion. I know when the dust settles and member of their family becomes ill? ble for free preventive care for rec- the provisions of the bill become clear, My friends, saying no to accessible, ommended services. Seniors will also America will be proud of it as well. affordable health care for the Amer- be eligible for free annual wellness vis- This landmark reform legislation in- ican people is too big a price to pay for its to their doctors, and will be pro- cludes State-based insurance ex- ideological purity. When I think of vided with a personalized prevention changes, creating a fair, open, competi- what this legislation will do, I cannot plan so they can stay healthy. tive marketplace for affordable cov- believe there will not be one vote on When this legislation is signed, we erage. It includes an amendment I pro- the other side to provide competition will have lived up to our promise to fill posed for long overdue consumer pro- and affordable choices for every Amer- the doughnut hole, that gap in cov- tections for emergency services. When ican, as this bill does; not one vote for erage under Medicare Part D, to pro- you are getting sent to a hospital, you greater accountability for health insur- vide affordable prescription drugs to are not thinking about calling your ance companies; not a vote for more over 227,000 seniors in New Jersey and company and saying: Is this the right choice and competition for consumers, millions across the country so they hospital? Am I going to be covered for programs that will rein in health will no longer have to choose between without regard to prior authorization? costs and make policies more afford- paying their bills and taking the medi- It requires insurance plans to provide behavioral health treatments, such as able. cation. Is this bill perfect? No. But it is a When this legislation is signed, over those for children who are autistic, as great and historic foundation of re- 850,000 New Jerseyans will qualify for part of the minimum benefits standard. form. Yet there will not be one vote on tax credits to help them pay for health It encourages investments in new ther- the other side to improve access to insurance, easing the burdens, pre- apy to prevent, diagnose, and treat quality care for children, as this bill miums, deductibles, and copayments. acute and chronic disease with a tax provides for, and the most vulnerable It will make tax credits for up to 50 credit for innovative biotechnology re- search. It ensures that minor children among us, which the bill does. Not a percent of health care premiums avail- qualify as exchange-eligible and pro- single vote for tougher accountability able to over 100,000 small businesses in vides for the availability of child-only policies, for health insurance compa- New Jersey. It will also put an end to health insurance coverage in the ex- nies that are included in this legisla- the hidden tax that is passed along to changes. It stops insurance companies tion? Not one vote to require insurers everyone in my State through in- from denying coverage for preexisting to spend more of the premium revenues creased premiums and costs to pay for conditions, health status, or gender, on health care rather than on adminis- the over $1 billion spent on uncompen- and it ends the medical benefits shell trative costs, executive compensation, sated care in New Jersey. game that insurers have played with and boosting the bottom line? Not a This legislation includes a health in- people’s lives. vote to hold health insurers account- surance exchange that would provide The bottom line is this legislation able for excessive rate increases? Not a portability, security, and choice for 1.3 helps New Jersey and America. It is single vote on the other side to imme- million New Jersey residents who pres- fair, balanced, and fixes a badly broken diately ban insurance companies from ently do not have any health insurance system. It is truly a historic piece of denying children—we hear a lot about whatsoever. It will increase the num- legislation and will be remembered as the sanctity of life—coverage for a pre- ber of doctors, nurses, and dentists for such. Yet every one of my colleagues existing condition? Not one vote for ex- the 150,000 New Jerseyans, 2 percent of on the other side will vote no. They panding eligibility for tax credits for the population who live in areas where will stand against all of it, all I have small businesses and starting the they do not have access to primary talked about, firmly, once again, on health insurance tax credit next year? care because of a shortage of health the wrong side of history. That is why it is interesting to note care providers in their communities, Let me conclude by saying, as I have that among the many supporters of yet there will not be one single vote for said before, and I will say again, his- this, the Business Roundtable, they are this legislation on the other side, not a tory calls on us to stand up on rare oc- quoted as saying: single vote for any of these health re- casions for what is fair and just and The proposed legislation is a step towards forms to help hard-working families in right for the American people. This is our shared goal of providing high quality, af- my State and in States across the one of those occasions. This is a time fordable health care for all Americans. country. to look into your heart, a time to see It is why the Small Business Major- This is the politics of no, pure and beyond your own political interests, ity says the managers’ amendment, simple. I suppose it is nice to say no to your own hard ideology, and look at Senator REID’s amendment, ‘‘includes health care reform when you have the the lives of millions of Americans. new provisions essential for small busi- full protection of health care yourself. Think about the millions of families on ness protection and survival.’’ That is But it is wrong to say you are unwill- Main Street, in every community, the voice of business. ing to afford the same protections to where a child wakes up in the middle of Not one vote for a bill that promotes others. It is nice to say no to health the night to a parent who cannot afford competition for insurers and choice for care reform when you and your family to get them the basic care they need. workers? Or to test alternatives to will not be denied coverage because of Ask yourself: What is the right thing civil tort legislation that emphasize the privileged position you hold but to do? patient safety, disclosure of health wrong to let even one mother, one fa- This is a time to do what is right for care errors, and resolutions of dis- ther hear that their child has been de- America. It requires more than par- putes? Not one vote. nied the medical treatment they des- liamentary maneuvers to slow the Not one vote for people in my home perately need. process. It requires more than shrill State of New Jersey and every State I say to my friends, how dare you voices raised under the banner of free who will see direct and immediate ben- stand in unison on the other side of the market values at the expense of funda- efits from this legislation? Not a vote aisle and deny to others that which you mental human values. It requires doing for every uninsured Jerseyan who has a so fully enjoy yourselves. How can you what is right for the millions of Amer- preexisting condition and has been un- deny to others that which you so fully ican families who have lost their jobs

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00054 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32960 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 and their health care, those who have the only private health insurance pol- medical expenses to beneficiaries. That suffered from the economic policies of icy she could afford. She was forced to is why I urged the managers to include the last 8 years and now find them- accept several riders for her pre- in the managers’ package a provision selves hurting. This is a time to re- existing conditions, arthritis and hay exempting from the tax only those member them, a time to remember fever, so her insurance ‘‘won’t cover nonprofits with very high payout rates. every mother who cries herself to sleep the problems that will soon need atten- Those good performers are committed at night because she lost her job, lost tion.’’ She also has to pay out-of-pock- to their policyholders rather than to her health care for herself and her in- et for most her preventative screenings profits for stockholders, which is the fant and could lose everything she and primary care because she has not goal of the for-profits. Those good per- struggled for in her life, if she gets reached her $5,000 deductible. She forming nonprofits are unable, as a re- sick. writes, ‘‘I feel I am paying $250 a sult, to absorb the fees. I say again to my friends, how dare month for unreliable health insur- The managers’ amendment specifies you deny to her the protections that ance.’’ Until she reaches Medicare age two ways for nonprofits to be exempt you so fully enjoy yourself. How dare or can qualify for Medicaid, her only from the fee. you turn this into a parliamentary option is to sell down her assets to pay The first way for a nonprofit insurer game of delay, deny, and defeat. Those the bills. to be exempt from the fee: one, it can who have continuously said no to any Like millions of Americans, Susan is not refuse to insure anyone in the attempt at health care reform and yes vulnerable in the non-group health in- State and is the State’s insurer of last to the needs of the insurance industry surance market, where coverage is resort; two, its premium prices are reg- believe that the business of govern- often expensive, inadequate and cer- ulated by its State insurance regu- ment is business. But for all of us who tainly not guaranteed. ‘‘Without the lator; and three, it must pay out in know the business of government, what security of group coverage,’’ she notes, medical expenses 100 percent or more it really is, it is about people. It is ‘‘I am very vulnerable and am one ill- of its premium revenues in the indi- about those who send us here. It is ness away from a catastrophe.’’ Several vidual market. their lives, their hopes, their dreams provisions in the Patient Protection The second way for a nonprofit to be for a better life for themselves and and Affordable Care Act will help exempt: the nonprofit insurer must pay their families. This is an opportunity Americans like Susan gain access to out a very high percentage of its pre- to stand up for them. This is an oppor- quality, affordable health insurance. mium dollars—at least 90 percent—in tunity to take care of their health Under the Senate reform bill, all medical expenses in each of the three care. This is an opportunity to show health insurers will be prohibited from major market segments: individual whose side you are on. using preexisting conditions to deny market, small group market, and the Are you on the side of those families health care and it will be illegal for large group market; and it also must or are you on the side of the special in- them to drop coverage when illness have an even higher overall payout terests that would have you vote no, or strikes. Health insurance exchanges rate of at least 92 percent. A nonprofit the ideological interests that would will create an accessible marketplace that compresses its margins that far have you vote no against these fami- for Americans to shop for the best plan beyond its peers for the benefit of its to meet their needs. Health insurers lies? This is historic legislation. I am policyholders also warrants the exemp- will offer national plans to all Ameri- afraid our friends on the other side will tion. cans under the supervision of the Office once again, as they did in Social Secu- These exemptions continue the dis- of Personnel Management, the same rity and Medicare, find themselves on tinction that our tax law has recog- entity that oversees health plans for the wrong side of history. nized—that true nonprofit insurance Members of Congress. Tax credits will I intend to be on the right side of his- providers should not be treated the be available to make insurance more tory and to vote yes on this legislation. same as their for-profit counterparts. I yield the floor. affordable for those who need assist- Mr. LEAHY. Mr. President, after Mr. JOHNSON. Mr. President, I wish ance, and the choice of doctor will be months of arduous work, the Senate today to recognize the progress made protected. These health insurance mar- will finally take the first significant on health care reform, as well as stress ket reforms demand greater account- step toward bringing needed reforms to the fact that we must press forward. ability from insurance companies while health care in this Nation. Opponents creating more choice and competition Americans face out-of-control health of reform have wasted much of the for consumers. care costs, great inequalities in access public’s time by provoking arguments Despite a commitment by some to over their distortions about what to care, eroding benefits, and the ever- kill reform and defend the status quo, health reform means. Opponents have increasing threat of losing their health I am confident the strong consensus on tried to demonize the plan, and have insurance. While it has not been an the urgent need for reform will prevail. easy task to reach a consensus, we find The cost of inaction is too great. claimed it will never work. We have ourselves very close to fixing our Mr. LEVIN. Mr. President, the health overcome weeks of delay tactics em- health care system and extending ac- insurance provider annual fee in the so- ployed by the minority—inexplicably, cess to health insurance to over 31 mil- called merged Senate health care re- the most recent delay due to a fili- lion Americans. form bill did not distinguish between buster against a bill to provide funding I have heard from countless South nonprofits and for-profit insurance for our troops. These are the tactics of Dakotans whose stories illustrate the companies in this country, although obstruction, and further demonstrate urgent need for reform. Just as the dis- our current tax law properly does make Republicans’ efforts to maintain the eases and health care emergencies they the distinction. status quo. face cannot be postponed, it is impera- I urged that the managers’ package Is this the exact bill that any one of tive we forge ahead and deliver reforms modify the fee to continue to recognize us would have written? Probably not. I that will improve their health and se- the distinction. remain disappointed that the man- curity. Imposing the annual fee on true non- agers’ amendment before us today I would like to share the story of profits, particularly those with high strips the bill of a public insurance op- Susan from Rapid City, SD, a 57-year- pay-out rates to beneficiaries, would tion to compete with private plans and old woman who has nearly depleted her have pushed many of those true non- does not include a provision I have savings and plans to sell her home in profits into deep financial difficulties sponsored to repeal the antitrust ex- order to pay her bills and medical ex- and would have caused significant emption for health insurers and med- penses. Her husband passed away sev- hardships on the families who rely on ical malpractice insurers. I believe eral years ago and she now survives on their services. both of these provisions would go far in his modest pension. After exhausting Some nonprofit insurers have not providing fair competition into the COBRA health insurance, she bought maximized the amount they pay out in health insurance market.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00055 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32961 But in looking at this bill as a whole, fraud. By making modest but impor- will allow for more vigorous enforce- I believe it stands by the core prin- tant changes to the law, it ensures that ment of those offenses, including mak- ciples I sought at the beginning of this those who drain our health care system ing their proceeds subject to criminal debate. It gives Americans affordable of billions of dollars each year, driving forfeiture. It also clarifies the intent access to health care coverage, it re- up costs and risking patient lives, will requirement of another key health care duces costs for families, businesses and go to jail, and that their fraudulent fraud statute in order to facilitate ef- government, and it protects con- gains will be returned to American tax- fective, fair, and vigorous enforcement. sumers’ ability to choose doctors, hos- payers and health care beneficiaries. The managers’ amendment also in- pitals and insurance plans. For more than three decades, I have cludes our provision amending the The managers’ amendment intro- fought in Congress to combat fraud and antikickback statute to ensure that all duced by the majority leader incor- protect taxpayer dollars. This spring, I claims resulting from illegal kickbacks porates many important changes to the introduced with Senator GRASSLEY and are considered false claims for the pur- underlying legislation that will im- Senator KAUFMAN the Fraud Enforce- pose of civil action under the False prove the bill. It includes several provi- ment and Recovery Act, the most sig- Claims Act, even when the claims are sions that I have long supported and nificant antifraud legislation in more not submitted directly by the wrong- promoted. than a decade. When that legislation doers themselves. All too often, health Vermont has always been a national was enacted, it provided law enforce- care providers secure business by pay- leader in expanding access to health in- ment with new tools to detect and ing illegal kickbacks, which needlessly surance. In coordinating care, offering prosecute financial and mortgage increases health care risks and costs. comprehensive coverage to children, fraud. Now, as health care reform This change will help ensure that the and developing a system of electronic moves through the Senate, I am glad government is able to recoup from health records, Vermont has been at we are taking steps to do all we can to wrongdoers the losses resulting from the forefront of reform. It is no sur- tackle the fraud that has contributed these kickbacks. prise that for the third year in a row greatly to the skyrocketing cost of The Kaufman-Leahy measure gives Vermont has been ranked the health- health care. the Department of Justice limited sub- iest State in the Nation. The scale of health care fraud in poena authority for civil rights inves- Unfortunately, a provision included America today is staggering. According tigations conducted pursuant to the in the underlying bill to expand Med- to even the most conservative esti- Civil Rights for Institutionalized Per- icaid coverage nationwide threatened mates, at least 3 percent of the funds sons Act. This provision allows the to penalize Vermont by excluding the spent on health care are lost to fraud— government to more effectively inves- State from increased Federal funding, more than $60 billion a year. In the tigate conditions in publicly operated solely because Vermont acted early to Medicare Program alone, the General institutions, such as nursing homes, do the right thing. We can all share the Accountability Office estimates that mental health institutions, and resi- goal of increasing access to essential more than $10 billon was lost to fraud dential schools for children with dis- medical services by expanding Med- just last year. While Medicare and abilities, where there have been allega- icaid coverage nationwide, but we Medicaid fraud is significant, it is im- tions of civil rights violations. should not penalize States such as portant to remember that health care These changes will strengthen our Vermont, which demonstrated the ini- fraud does not occur solely in the pub- ability to crack down on fraud and will tiative to expand its Medicaid Program lic sector. Private health insurers also ultimately result in significant savings early. see billions of dollars lost to fraud. that will make health care more effi- Senator REID’s amendment, however, That fraud is often harder for the gov- cient and more affordable. remedies the anomaly in the under- ernment to track. Private companies I am also pleased Senator REID’s lying bill, and will allow Vermont to have less incentive to report it, and in amendment includes a key reform to access additional Federal funding when some cases, are responsible for the the False Claims Act that Senator the Medicaid expansion goes into ef- fraudulent practices themselves. Rein- SANDERS, Senator GRASSLEY, and I fect. I thank Senators REID and BAUCUS ing in private sector fraud must be a have proposed. By fixing the False for working with me to ensure that part of any comprehensive health care Claims Act’s public disclosure provi- Vermont’s efforts to expand coverage reform. sion, we can ensure that we fairly and to low income individuals is not set The Kaufman-Leahy provision makes appropriately empower whistleblowers back by inequities in the underlying a number of straightforward, impor- to come forward to expose fraud, which legislation. tant improvements to existing statutes is a crucial way to save the govern- The managers’ amendment also in- to strengthen prosecutors’ ability to ment money and ensure the health and corporates a vital antifraud amend- combat health care fraud. The bill well-being of Americans. ment Senator KAUFMAN and I, as well would increase the Federal sentencing We all agree that reducing the cost of as Senators SPECTER, KOHL, SCHUMER, guidelines for health care fraud of- health care for American citizens is a and KLOBUCHAR, introduced, derived fenses. Despite the enormous losses in critical goal of health care reform. We from the Health Care Fraud Enforce- many health care fraud cases, offenders in Congress must do our part by ensur- ment Act which we introduced earlier often receive shorter sentences than ing that, when we pass a health care this fall. other white-collar criminals. This reform bill, it includes all the tools and This antifraud initiative builds on lower risk is one reason criminals are resources needed to crack down on the the impressive steps the administra- drawn to health care fraud. By increas- scourge of health care fraud. This pro- tion has already taken to step up ing the Federal sentencing guidelines vision is an important part of that ef- health care fraud prevention and en- for health care fraud offenses, we send fort. forcement, and on the real progress a clear message that those who steal I am also very encouraged that the represented by the antifraud provisions from the Nation’s health care system amendment before us includes a meas- adopted by the Finance and HELP will face swift prosecution and substan- ure I proposed with Senator BROWN to Committees and incorporated into the tial punishment. expand Federal Tort Claims Act med- leader’s health care reform bill. I was The provision provides for a number ical malpractice coverage for free med- glad to contribute to those efforts, and of statutory changes to strengthen ical clinics. This expanded coverage I am glad we are now going even fur- fraud enforcement. For example, it will help free clinics across the Nation ther. would expand the definition of a ‘‘Fed- continue to provide and improve a crit- The Kaufman-Leahy provision will eral health care fraud offense’’ to in- ical safety net for many Americans. provide prosecutors with needed tools clude violations of the antikickback In 1996, Congress enacted legislation for the effective investigation, prosecu- statute and several other key health to cover volunteer medical profes- tion, and punishment of health care care-related criminal statutes, which sionals in free clinics with medical

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00056 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.001 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32962 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 malpractice liability insurance prising that frequently they have ar- I am disappointed, however, that the through the Federal Tort Claims Act. gued for one of their pet proposals— Health Insurance Antitrust Enforce- This coverage protects volunteer med- medical malpractice reform. For as ment Act, which I introduced in Sep- ical staff against liability by sub- long as I have served in this Chamber, tember, was not part of the managers’ stituting the Federal Government for I have fought against court-stripping amendment, and will not be part of the an individual defendant. But without measures that limit American’s access Senate’s health reform legislation. any explanation in the legislative his- to their justice system. I have also That legislation would repeal the anti- tory, the coverage enacted in 1996 fought to protect the sovereignty of trust exemption for health insurers and failed to provide coverage for others States to make rules for their own jus- medical malpractice insurers, and is an who are essential to the operation of tice systems. Medical malpractice integral part of injecting competition free clinics, such as nonmedical staff, claims are based on State law and for into the health insurance market. contractors, board members, and the the most part take place in State While there are differing views on the clinic itself. As a result, free clinics courts. I find it curious that some of best way to inject competition into the must use scarce funding to purchase in- the same Senators who pledge loyalty health insurance market, we can all surance on the private market to fill to federalism and the sovereignty of agree that health and medical mal- the States under the tenth amendment this gap. This lack of comprehensive practice insurers should not be allowed are some of the same Senators who are coverage for free clinics is inconsistent to engage in blatantly anticompetitive so aggressively pushing for a Federal with the coverage provided to commu- practices, such as colluding to set ‘‘one-size-fits-all solution’’ for the jus- nity health centers, which benefit from prices and allocating markets. My re- coverage for all employees. This provi- tice systems in our 50 States. The managers’ amendment includes a peal would ensure that basic rules of sion will remedy this discrepancy. fair competition will apply to insurers, This measure will have no impact on provision addressing malpractice li- ability that has been introduced on a and is nonpartisan. the legal rights of a patient injured by bipartisan basis several times over the My amendment was cosponsored by a medical error; any victim of medical past few years. I support this provision 23 Senators, and has support from a malpractice will still be able to pursue because it respects the States’ primary cross-section of consumer rights orga- a remedy for an injury under the Fed- role in adjudicating the claims of pa- nization. I look forward to working to eral Tort Claims Act. Instead, this tients injured or killed by medical er- include this repeal when the Senate amendment will free up scarce re- rors. I also support this provision be- and House conference to reconcile their sources that are currently being used cause it resists the notion that ‘‘one- versions of the legislation. to purchase liability insurance on the size-fits-all’’ when it comes to litiga- The managers’ amendment will im- private market. Informal estimates in- tion issues and it includes the nec- prove the underlying bill, and I hope dicate that this amendment could save essary safeguards for patients. I note my fellow Senators will support its free clinics across the country $15 to for the RECORD that several States’ ef- passage so we can move toward final $20 million a year. These are funds that forts to reform medical malpractice li- passage of the bill. Each day that will be redirected to providing essen- ability have been struck down as un- passes without reform, 30 more tial medical services to low-income and constitutional. For example, Alabama, Vermonters lose their health insur- other Americans in need. For example, Florida, Georgia, Illinois, Kansas, New ance. We know our current health sys- as a result of this amendment, the Hampshire, Ohio, Oregon, South Da- tem is unsustainable. That threatens Viola Startzman Free Clinic in Woos- kota, Washington, and Wisconsin have not only our health security, but also ter, OH, will save $17,000 a year. The all enacted caps on damages associated our economic security. Doing nothing Americares Clinic in Stamford, CT, with medical malpractice claims. And has been seen as an option before, but will save $31,000 each year. Our hard- all of those State laws were struck it simply is not an option now. working free clinics in Vermont will down as unconstitutional for good rea- I hope now we can work together to save $12,000 each year and will be able son. I am heartened that no such pass a bill that will give millions more to put those savings toward helping amendment was seriously considered in Americans access to quality, affordable Vermonters in need of health care serv- this Chamber because such arcane health care. We should reject the tac- ices. For free clinics operating through measures hurt our children, our senior tics of delay and the efforts to ob- volunteerism and private donations citizens, and stay-at-home moms. The struct, and remember that the Senate and in a difficult economy, these are Wall Street Journal has reported on should be the conscience of the Nation. substantial sums that if devoted to the this clear fact when it pointed out that With the Christmas season upon us, our care of Americans in need will have a these caps deprive these groups of ac- constituents are looking to us to do significant positive impact. cess to justice. If we create Federal the right thing. We should adopt this And the savings realized through this caps on their ability to recover from amendment, advance this legislation, amendment will cost the taxpayers lit- serious injuries we are telling them and work to send it to the President tle if anything. Free clinics do not per- that they are worth less because they without undue delay. form high-risk procedures such as ob- are retired or they choose to stay home stetrics or surgeries, and thus are sub- and raise a family or are young chil- Mr. GRASSLEY. Mr. President, one ject to a lesser risk of liability. Since dren. This is not fair. I know that no longstanding priority of mine has been 2004, when funds were first appro- doctor wants to harm a patient, but to improve Medicare payments for hos- priated and set aside to cover any the solution is not to take away the pitals known as tweeners. They tend to claims against free clinic doctors, no rights of patients who are seriously in- have too many beds, so they can’t qual- claims have been filed. The bottom line jured. ify as critical access hospitals, but is that this amendment represents sig- The provision in the managers’ they do not have sufficient volume to nificant value to Americans in need of amendment does not encourage draco- operate viably under Medicare’s pro- health care services at little cost to nian damages caps and does not dictate spective payment systems. There are a the government and the taxpayer. what reforms States must consider. number of these tweener hospitals in I thank Senator BROWN for his sup- Importantly, however, it does include Iowa. port as a cosponsor, and I thank the specific patient protections that must Working closely with the Iowa Hos- majority leader, Senator HARKIN, and be in place before a State can receive a pital Association and individual Iowa Senator BAUCUS for working with me grant for liability reform measures. To hospitals over the years, I introduced, to make this amendment part of the the extent that States can pass meas- last Congress, the Rural Hospital As- historic legislation before the Senate. ures that improve patient safety as sistance Act of 2008, S. 3300, which Over the course of the past month, I well as expedite damages recovery for would improve the low-volume adjust- have listened to many of my friends on victims, those reforms will truly im- ment for hospitals under Medicare’s the other side of the aisle. It is not sur- prove our health care system. hospital inpatient prospective payment

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00057 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32963 system. This improvement would en- told. The votes include accepting this plants closing down almost immediately able tweener hospitals to benefit from new Reid managers’ package, cloture after January 1. And the nation will lose a this adjustment. on the original Reid substitute, accept- vital link in its effort to reduce our depend- In fact, the low volume adjustment ing the original Reid substitute, clo- ence on foreign oil. provision in the Finance Committee’s ture on the underlying bill, and finally As we continue our important busi- health reform bill, S. 1796, and the Reid the final passage of his colossal mis- ness, I implore my colleagues on the substitute to H.R. 3590 is the language take. Since I am opposed to each one of other side of the aisle to work to get that I crafted. This language was craft- these votes, I will not remain in Wash- the extenders finished this year and to ed with the intention of benefiting all ington to vote against these procedural include the renewal of the biodiesel tax Iowa tweener hospitals. I was assured maneuvers since that will have the credit. by the Iowa Hospital Association that same effect as voting no, and will re- f this language would do so, and they turn to vote against final passage of supported it. this bill. LIU XIAOBO Unfortunately, after the Finance f Mr. LEAHY. Mr. President, I want to Committee markup of S. 1796, I learned speak briefly about the indictment and from the Iowa Hospital Association MORNING BUSINESS trial by Chinese authorities of Mr. Liu that the language they originally sup- Mr. DURBIN. Mr. President, I ask Xiaobo for ‘‘incitement of state subver- ported would not benefit all Iowa unanimous consent that the Senate sion.’’ The evidence cited in support of tweener hospitals. I was informed that proceed to a period of morning business the charges were Mr. Liu’s essays and several Iowa tweener hospitals had with Senators permitted to speak for association with Charter 08, a frame- Medicare discharges in excess of the up to 10 minutes each. work for democracy, human rights and maximum in the provision, which was The PRESIDING OFFICER. Without the rule of law that was made public a 1,500. objection, it is so ordered. year ago this month. In an attempt to make sure that all f That document was signed by Mr. Iowa tweener hospitals benefit from Liu and some 300 other intellectuals this provision, I filed an amendment THE IMPORTANCE OF RENEWING and activists. Thousands more people that would increase the maximum THE BIODIESEL TAX CREDIT have since added their names, most of number of Medicare discharges from Mr. MCCONNELL. Mr. President, on them from inside China. I am told that 1,500 to 1,600. This amendment was also December 31, 2009, the current biodiesel Charter 08 is widely regarded as the offset. My staff was successful in work- tax credit will expire. This tax credit most significant democratic reform ing with the majority staff to include increases domestic demand and pro- movement in China in a decade. my amendment in the manager’s vides an incentive for U.S. producers to The charges against Mr. Liu are very amendment to the Reid substitute. increase investment and output. It is disappointing. They illustrate how lit- Mr. INHOFE. Mr. President, on Mon- essential in producing biodiesel and al- tle has improved in China regarding day morning at 1 a.m., I voted no on lowing it to compete with petroleum tolerance for freedom of expression. I the cloture motion to the latest Reid diesel. Without the tax credit, petro- am informed that the Chinese Govern- managers’ package, which was only leum marketers will be unwilling to ment has decided to bring Mr. Liu to made available Saturday, because I am purchase the more expensive biodiesel, trial, that international observers are adamantly opposed to this $2.5 trillion and demand will be heavily reduced. permitted under Chinese law, and this government-run health care system As all of my colleagues know, the is consistent with international legal 1 with its $ ⁄2 trillion increase in taxes on biodiesel tax credit provides a $1-per- standards on the openness and trans- 1 Americans and nearly $ ⁄2 trillion in gallon credit for biodiesel made from parency of legal proceedings. I mention cuts to Medicare to help pay for it. I soybean oil or yellow grease and ani- this because I am aware that former am opposed to public financing of abor- mal fats. The original version of this Governor of Pennsylvania and U.S. At- tion this bill allows. I am opposed to a tax credit was passed in 2004 and has torney General Richard Thornburgh fac¸ade of health care reform that in no been extended twice, most recently in has expressed a strong interest in at- way seriously addresses tort reform October 2008. tending the trial as an observer, to and will only increase premiums and As a result, the U.S. biodiesel indus- show support for Mr. Liu and to convey the cost of health care for all Ameri- try has grown significantly over the the concern that he and others around cans. I am opposed to the special deals past several years, providing not just the world have for the larger implica- for only certain States in this bill to jobs but also the green jobs this admin- tions of this case. buy off votes. I am opposed to the spe- istration and many of my friends on The arrest of Mr. Liu demonstrates a cial deals for only certain States in the other side of the aisle have so ada- continuing, disturbing trend in China. this bill to buy off votes. I am opposed mantly supported. However, the com- As Governor Thornburgh has written: to the increased burden of at least $26 bination of volatile commodity prices in recent years, China’s leaders seemed to billion on States including Oklahoma and weak motor fuel demand caused by be tolerating changes in the legal system. mandated under this bill. I am opposed the current recession has severely af- The number of private lawyers and law firms to no serious effort at all to include fected the biodiesel industry for the has grown exponentially. Lawyers and citi- any amendments from Republicans. worse and therefore increases our ur- zens energetically began pursuing rights in Republican amendments to block tax gency to extend the credit today. court. A ‘‘wei quan,’’ or ‘‘rights defense’’ increases, block cuts to Medicare, im- In Kentucky, public school districts, movement, grew up around lawyers and ac- tivists seeking to use the laws on the books, pose tort reforms, try to impose some universities, National and State parks, kind of discipline on the government and the institutions allowed by law, to as- local governments, and the Transpor- sert and defend human rights without chal- take-over of health care in this coun- tation Cabinet are using biodiesel lenging the underpinnings of China’s com- try, among other amendments and mo- blends. These institutions and many munist system. Such efforts were tolerated tions have failed by nearly party-line Kentucky employers, including manu- at first, and there were even modest signs of votes. I am opposed to this bill, and facturers in Kentucky, will be hurt be- greater professionalism in the communist ju- most importantly, the American people ginning on January 1 if we allow this dicial system. are opposed to this bill. They know tax credit to expire. One executive of a Unfortunately, initial signs of progress have given way to serious setbacks. Many this bill is a complete disaster. The biofuel manufacturing facility wrote to next few votes leading up to the final lawyers who take on politically-sensitive me to say: cases have been subject to a kind of back- vote on this package are all procedural The $1-per-gallon tax incentive is truly the door disbarment, finding it impossible to votes, and I will be opposed to them difference between the survival and collapse renew their licenses. Some lawyers have all. But all 60 Democrats will vote for of this important industry. Without this tax been the target of surveillance, confined to them. Democrats do what they are incentive, thousands of jobs will be lost with house arrest, the victims of physical attacks,

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00058 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32964 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 raids and confiscation of their property. Law tion, the United States entered into of this conference report that means a firms and other groups pursuing law in the military alliances with Indian nations great deal to many American Indian public interest have been shut down. to secure assistance in winning our tribal leaders in this country, to sev- Moreover, there has been an alarming in- crease in the use of ‘‘subversion’’ or state se- independence. As a nation, we pledged eral of my colleagues and to me person- curity charges leveled against activists. to respect the rights of Indian nations ally, the Native American apology res- These cases have become a substitute for the to self-government, self-determination olution. old ‘‘counter-revolutionary’’ crimes. Others and territorial integrity. I am very pleased to report that with convicted on such grounds include Hu Jia, Our Constitution recognizes native the addition of this language in the de- the AIDS activist who also criticized abuses nations as prior sovereigns, with a con- fense appropriations conference report, surrounding the staging of the Summer 2008 tinuing right to self-government in the we—the United States of America—will Olympic Games and Huang Qi, who posted Indian commerce, apportionment, trea- officially apologize for the past ill-con- public information on his website about the ty and supremacy clauses. The United ceived policies and maltreatment by government’s response to the Sichuan earth- quake. States entered into 370 treaties with the United States toward the Native Liu’s prosecution requires a serious re- Indian nations and treaties of peace, peoples of this land. sponse from the United States. Cooperating friendship and commerce with the With the passage of this language, with China on other issues like the environ- Kingdom of Hawaii. In many ways, the we, as a Nation, will reaffirm our com- ment or North Korea does not mean we must United States broke these treaties and mitment toward healing our Nation’s silence ourselves when it comes to the rights engaged in acts of war against our Na- wounds rooted in a difficult past of and freedoms of China’s citizens. Indeed, we tive peoples, taking lands by force, dis- Federal-tribal relations and work to- are unlikely to get meaningful cooperation on any issue when we appear weak in defense placing Native peoples and leaving ward establishing better relationships of our principles, which as President Obama them in poverty and suffering. At rooted in reconciliation and forgive- has said many times—most recently in his times, the United States informed in- ness. speech accepting the Nobel Peace Prize—are digenous, Native peoples that their Native Americans have a vast and universal principles. continued residence on their original proud legacy on this continent. Long I agree, and hope the Chinese au- lands would be considered an act of war before 1776 and the establishment of thorities reconsider this case, release against the U.S. and if they did not the United States of America, native Mr. Liu, and dismiss the charges leave, U.S. military forces commenced peoples inhabited this land and main- against him. There are so many issues wars, imprisoned and killed Native tained a powerful physical and spir- on which we want to expand our co- leaders and people, and tragically, at itual connection to it. In service to the operation with China, but the persecu- places like Sand Creek and Wounded Creator, Native peoples sowed the land, tion of courageous Chinese citizens Knee massacred Native men, women, journeyed it, and protected it. The peo- who are guilty of nothing more than and children. ple from my State of Kansas have a exercising rights guaranteed by the Congress and the executive branch similar strong attachment to the land. Universal Declaration of Human Rights enacted laws and policies that took Na- Like many in my State, I was raised hinders that cooperation and China’s tive children out of their homes and on the land. I grew up farming and car- own development. forced them to attend boarding ing for the land. I and many in my If the charges are not dismissed, and schools, far from their families in an State established a connection to this Mr. Liu is brought to trial, his trial effort to suppress Native cultures and land as well. We care for our Nation should be attended by outside observ- languages. Our Nation denied Indian and the land of our forefathers so ers including top officials of the U.S. nations religious freedom. And these greatly that we too are willing to serve Embassy and Governor Thornburgh. I wrongs did not end in the 19th century. and protect it, as faithful stewards of hope the Department of State and our The United States continued to take the creation with which God has diplomats in Beijing will assist Gov- Native lands for various purposes, and blessed us. I believe without a doubt ernor Thornburgh, including in obtain- in many cases has failed to safeguard citizens across this great Nation share ing a visa and access to the trial. It is Native lands, waters, and resources. this sentiment and know its unifying important that the Chinese Govern- For these things, our Nation should power. Americans have stood side by ment, and the Chinese people, know and now does apologize. I commend my side for centuries to defend this land how strongly we deplore what is being colleagues, Senator BROWNBACK, Sen- we love. done to Mr. Liu, and what it says about ator DORGAN and our Senate Appro- Both the Founding Fathers of the the need for China to meet its own priations chairman, Senator INOUYE, United States and the indigenous commitments to respect internation- for leadership on this important and tribes that lived here were attached to ally recognized human rights. historic apology. I know from experi- this land. Both sought to steward and f ence that an apology can bring healing protect it. There were several instances and reconciliation. Congress passed the of collegiality and cooperation between NATIVE AMERICAN APOLOGY Native Hawaiian Apology Resolution, our forbears—for example, in James- RESOLUTION Public Law 103–150, in 1993 and it has town, VA, Plymouth, MA, and in aid to Mr. AKAKA. Mr. President, today, I had a profound impact. explorers Lewis and Clark. want to speak about a matter of sig- I encourage President Obama to issue Yet, sadly, since the formation of the nificance to our Nation. As part of the an apology to our Native peoples that American Republic, numerous conflicts Defense appropriations bill, Congress truly reflects the many wrongs that we have ensued between our government, has enacted an apology to our Native should apologize for to Native peoples. the Federal Government, and many of Peoples for the historical wrongs that The strength and resilience of our in- these tribes, conflicts in which war- our Nation has committed against digenous people, America’s first people riors on all sides fought courageously them. I am proud to have served as a must be acknowledged. Despite the and which all sides suffered. Even from cosponsor of the stand-alone apology many transgressions made against our the earliest days of our Republic there resolution, S.J. Res 14, and commend Nation’s first people, American Indi- existed a sentiment that honorable Senators BROWNBACK, DORGAN, and ans, Alaska Natives, and Native Hawai- dealings and a peaceful coexistence INOUYE for ensuring this needed apol- ians continue to make meaningful con- were clearly preferable to bloodshed. ogy will be made. tributions to the United States. This Indeed, our predecessors in congress in From the beginning, Native peoples apology will be a historic act that can 1787 stated in the northwest ordinance: welcomed early colonists at Plymouth bring reconciliation and healing be- ‘‘The utmost good faith shall always Rock and in Virginia, and in my home tween our Native peoples and the be observed toward the Indians.’’ State of Hawaii, the Kingdom of Ha- American people as a whole. Today we live up to this goal, today, waii extended the aloha spirit to our Mr. BROWNBACK. Mr. President, I we right a wrong that has been com- visitors. During the American Revolu- would also like to highlight a section mitted in this Nation.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00059 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32965 This amendment extends a formal During the Depression when times example, during the Christmas season apology from the United States to trib- were very tough and my family was the nursery creates stunning fresh cen- al governments and Native peoples na- struggling, Annie loaned my father terpieces and grows its own brilliant tionwide—something we have never $500, an act of real generosity in tough red poinsettias. Additionally, aside done; something we should have done times. Over the years, I have visited from Christmas trees and wreaths, the years and years ago. her many times, sought her advice, sa- company stocks a variety of garlands, Further, this resolution will not re- vored her excellent cooking, and en- roping, and other timely decorating solve the many challenges still facing joyed her company. supplies and ornaments to bring home Native Americans, nor will it author- My first visit was to Chicago, where the memorable sights and smells of the ize, support or settle any claims she has lived for many years. There I season. against the United States. It doesn’t saw the marvels of the World’s Fair. I Beyond its role as a stellar nursery, have anything to do with any property rode in a scary cable car over Lake Estabrook’s prides itself as being an claims against the United States. That Michigan and was hoisted on to the extraordinarily active member of the is specifically set aside and not in this stage by my father on a sideshow with local community. The company has bill. an Indian chief. This occurred in the widely promoted the Herbie Project, an What this amendment achieves is midst of the Depression when my fam- undertaking to save New England’s recognition, honor, and the importance ily was en route from Wichita, KS, largest American Elm Tree, known to of Native Americans to this land and to where we had lived, to Philadelphia, locals as Herbie. This initiative is par- the United States in the past and today PA, to live with my father’s sister be- ticularly noteworthy given that Yar- and offers an official apology for the cause my father could not earn a living mouth has lost roughly 800 American poor and painful path the U.S. Govern- in Kansas. Elm trees to Dutch Elm Disease over ment sometimes made in relation to Recently, not unexpectedly, Annie the past fifty years. Additionally, our Native brothers and sisters by dis- has become infirm. When I have visited Estabrook’s has donated its gift certifi- regarding our solemn word to Native in recent years, it has been difficult to cates, cleverly known as ‘‘Estabucks,’’ peoples. It recognizes the negative im- talk to her, but last night we had a to community efforts, including the pact of numerous destructive Federal nice conversation over the phone. Holiday Boast N Toast Auction to ben- acts and policies on Native Americans Her longevity has set a remarkable efit the Yarmouth Chamber of Com- and their culture, and it begins—be- family record evidencing good genes merce’s Scholarship Fund and gins—the effort of reconciliation. and setting a Strom Thurmond-like YarmouthCAN, a nonprofit that assists Apologies are oftentimes difficult, target to emulate. She is a wonderful those needing a helping hand. The but like treaties, go beyond mere words woman, a wonderful aunt, and a won- nursery has also taken great strides to- and usher in a true spirit of reconciling derful role model. ward creating the Yarmouth Commu- past differences and help to pave the Happy Birthday, Tante Annie! nity Garden, which raises vegetables way toward a united future—a future f that are then donated to the area’s dis- that transcends the individual but advantaged individuals and families. strives to reach into eternity. The no- ADDITIONAL STATEMENTS A well-known and trusted name in tion of the creation of the ‘‘Beloved the community for over half a century, Community’’ that Dr. King spoke of RECOGNIZING ESTABROOK’S Estabrook’s is a valued business in the . . . that my good friend representative town of Yarmouth because of its long- JOHN LEWIS speaks of is very appro- ∑ Ms. SNOWE. Mr. President, with standing dedication to quality green- priate at this moment for this time. Christmas just a few short days away, ery and its visible presence in civic en- ‘‘The end is reconciliation, the end is we have all witnessed the signs of the deavors townwide. I thank everyone at redemption, the end is the creation of season popping up in our neighbor- Estabrook’s for their caring and kind the beloved community.’’ This is our hoods. From vibrant wreaths and commitment to others, and wish them goal; this is my hope for our Nation Christmas trees to wind-blown snow a happy and safe holiday season.∑ banks, these peaceful symbols provide united as one people. f many of us with a comforting feeling of f home. Today I recognize a small Maine SOUTH DAKOTA SCHOOL OF MINES AUNT ANNE IS 100 YEARS OLD nursery that grows its own beautiful AND TECHNOLOGY TODAY poinsettias, and supplies many other ∑ Mr. THUNE. Mr. President, today I Mr. SPECTER. Mr. President, today seasonal flora, to accentuate the beau- recognize the South Dakota School of is a momentous day in the history of ty of the Christmas season. Mines and Technology, which will cele- the Specter/Shanin family. My aunt Estabrook’s has been a reliable fam- brate their 125th anniversary in 2010. Anne Shanin Kleiman is 100 years old. ily-owned, full service garden center Located in Rapid City, the South Da- My Tante Annie, that’s the Jewish for more than 50 years. Located in the kota School of Mines and Technology name for Aunt Annie, is the younger coastal town of Yarmouth, Estabrook’s has been a national leader in preparing sister of my mother, Lillie Shanin grows fresh plants in its over 20 green- world-class engineers and scientists Specter. Annie is an outstanding schol- houses and outdoor growing areas. The since 1885. Graduates design, construct, ar who published a book on Hebrew po- company also operates seasonal loca- and operate the most modern tech- etry. tions in Scarborough and, beginning nology to meet complex challenges She was the first person who taught earlier this year, in Kennebunk. Home such as climate change, bioenergy, me about Israel. She traveled to Israel to an abundance of trees and shrubs, mineral extraction and processing, ad- before Israel was declared a state, when perennial and annual flowers, and seeds vanced materials, environmental qual- it was called Palestine. She sent me a for growing vegetables, Estabrook’s ity, and national defense. School of beautiful wooden camel as a starting also carries a variety of gardening sup- Mines alumni are held in the highest point to describe Biblical Canaan plies, such as chemicals, fertilizers and regard by their fellow leaders in indus- which later was called Palestine and is tools. In an effort to better inform its try, consulting, government, health, now Israel. customers about the wonders of gar- research, and education. Annie married a distinguished sci- dening, Estabrook’s user-friendly The School of Mines is proud to be a entist/chemist, Dr. Morton Kleiman, website offers a variety of tips and best leading partner in bringing the Deep and had two brilliant children, Dr. practices regarding caring for flowers Underground Science and Engineering Adina Sue Kensky and Dr. Jay and plants. Laboratory, DUSEL, from an extraor- Kleiman who has two accomplished To properly celebrate the holidays, dinary vision to a phenomenal reality. children and two adorable grand- Estabrook’s provides its clients with The longstanding connections between children. an abundance of seasonal items. For the School of Mines and the Homestake

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00060 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32966 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 Mine began in 1885 when the university EC–4128. A communication from the Direc- tration, transmitting, pursuant to law, the was established to meet the growing tor of the Regulatory Management Division, General Services Administration’s Office of research needs of the mining industry, Office of Policy, Economics, and Innovation, Inspector General’s Semiannual Report for led by Homestake. These connections Environmental Protection Agency, transmit- the period of April 1, 2009 through September ting, pursuant to law, the report of a rule en- 30, 2009; to the Committee on Homeland Se- continued when nearly a decade ago, titled ‘‘Change of Address for Submission of curity and Governmental Affairs. the School of Mines helped champion Certain Reports; Technical Corrections’’ EC–4138. A communication from the Dep- the conversion of the mine into a na- (FRL No. 9093–5) received in the Office of the uty Secretary of Defense, transmitting, pur- tional laboratory. Today, as we con- President of the Senate on December 15, 2009; suant to law, the Department’s Office of In- tinue to prepare leaders in engineering to the Committee on Environment and Pub- spector General’s Semiannual Report for the and science, we are collaborating with lic Works. period of April 1, 2009 through September 30, EC–4129. A communication from the Direc- our colleagues to transform Homestake 2009; to the Committee on Homeland Secu- tor of the Regulatory Management Division, rity and Governmental Affairs. into a world-class laboratory to further Office of Policy, Economics, and Innovation, EC–4139. A communication from the Staff exceptional research and discoveries Environmental Protection Agency, transmit- Director, United States Commission on Civil not yet imagined. ting, pursuant to law, the report of a rule en- Rights, transmitting, pursuant to law, the Rugged individuals and pioneers in titled ‘‘Approval and Promulgation of Air report of the appointment of members to the engineering and science founded the Quality Implementation Plans; California; Iowa Advisory Committee; to the Committee School of Mines’ intellectual environ- Monterey Bay Region 8-Hour Ozone Mainte- on the Judiciary. ment more than a century ago. The nance Plan’’ (FRL No. 8983–4) received in the EC–4140. A communication from the Acting university’s faculty, staff, students, Office of the President of the Senate on De- Chief of the Border Security Regulations cember 15, 2009; to the Committee on Envi- Branch, Office of the Secretary, Department and alumni carry on that tradition ronment and Public Works. of Homeland Security, transmitting, pursu- today. In 2010, the School of Mines EC–4130. A communication from the Direc- ant to law, the report of a rule entitled ‘‘Ad- celebrates 125 years of award-winning tor of the Regulatory Management Division, ministrative Process for Seizures and For- faculty, staff, and students collabo- Office of Policy, Economics, and Innovation, feitures Under the Immigration and Nation- rating to solve issues of critical impor- Environmental Protection Agency, transmit- ality Act and Other Authorities’’ (RIN1651– tance to South Dakota, the nation, and ting, pursuant to law, the report of a rule en- AA58) received in the Office of the President the world. Please join me as we cele- titled ‘‘Approval and Promulgation of Main- of the Senate on December 15, 2009; to the tenance Plan for Carbon Monoxide; State of Committee on the Judiciary. brate their legacy of educating the Arizona; Tucson Air Planning Area’’ (FRL EC–4141. A communication from the De- leaders of tomorrow.∑ No. 8982–4) received in the Office of the Presi- partment of State, transmitting, pursuant to f dent of the Senate on December 15, 2009; to law, a report relative to the transfer of de- the Committee on Environment and Public tainees (OSS Control No. 2009–2057); to the MESSAGES FROM THE PRESIDENT Works. Committee on the Judiciary. Messages from the President of the EC–4131. A communication from the Sec- EC–4142. A communication from the Assist- United States were communicated to retary of Health and Human Services, trans- ant Attorney General, Office of Legislative the Senate by Mrs. Neiman, one of his mitting, pursuant to law, a report entitled Affairs, Department of Justice, transmit- secretaries. ‘‘National Coverage Determinations’’; to the ting, pursuant to law, the Fourth Quarterly Committee on Finance. Report from the Attorney General to Con- f EC–4132. A communication from the Chief gress; to the Committee on Veterans’ Af- EXECUTIVE MESSAGES REFERRED of the Trade and Commercial Regulations fairs. Branch, Customs and Border Protection, De- EC–4143. A communication from the Sec- As in executive session the Presiding partment of Homeland Security, transmit- retary of the Federal Trade Commission, Officer laid before the Senate messages ting, pursuant to law, the report of a rule en- transmitting, pursuant to law, a report enti- from the President of the United titled ‘‘Countries Whose Pleasure Vessels tled ‘‘Federal Trade Commission Report to States submitting sundry nominations May Be Issued Cruising Licenses’’ (CPB Dec. Congress on The U.S. SAFE WEB Act: The which were referred to the appropriate 08–27) received in the Office of the President First Three Years’’; to the Committee on committees. of the Senate on December 15, 2009; to the Commerce, Science, and Transportation. (The nominations received today are Committee on Finance. f EC–4133. A communication from the Chief printed at the end of the Senate pro- of the Publications and Regulations Branch, REPORTS OF COMMITTEES ceedings.) Internal Revenue Service, Department of the The following reports of committees f Treasury, transmitting, pursuant to law, the report of a rule entitled ‘‘Permitted Dis- were submitted: EXECUTIVE AND OTHER parity in Employer-Provided Contributions By Mrs. BOXER, from the Committee on COMMUNICATIONS or Benefits’’ (Rev. Rul. 2009–40) received in Environment and Public Works, without The following communications were the Office of the President of the Senate on amendment: December 10, 2009; to the Committee on Fi- H.R. 2188. A bill to authorize the Secretary laid before the Senate, together with of the Interior, through the United States accompanying papers, reports, and doc- nance. EC–4134. A communication from the Chief Fish and Wildlife Service, to conduct a Joint uments, and were referred as indicated: of the Publications and Regulations Branch, Venture Program to protect, restore, en- EC–4126. A communication from the Direc- Internal Revenue Service, Department of the hance, and manage migratory bird popu- tor of the Regulatory Management Division, Treasury, transmitting, pursuant to law, the lations, their habitats, and the ecosystems Office of Policy, Economics, and Innovation, report of a rule entitled ‘‘Unpaid Loss Dis- they rely on, through voluntary actions on Environmental Protection Agency, transmit- count Factors for 2009’’ (Rev. Proc. 2009–55) public and private lands, and for other pur- ting, pursuant to law, the report of a rule en- received in the Office of the President of the poses (Rept. No. 111–111). titled ‘‘Revisions to the California State Im- Senate on December 10, 2009; to the Com- f plementation Plan, South Coast Air Quality mittee on Finance. Management District’’ (FRL No. 9087–3) re- EC–4135. A communication from the Sec- INTRODUCTION OF BILLS AND ceived in the Office of the President of the retary of Health and Human Services, trans- JOINT RESOLUTIONS Senate on December 15, 2009; to the Com- mitting, pursuant to law, a report entitled The following bills and joint resolu- mittee on Environment and Public Works. ‘‘Report to Congress on Head Start Efforts to EC–4127. A communication from the Direc- tions were introduced, read the first Prevent and Reduce Obesity in Children’’; to and second times by unanimous con- tor of the Regulatory Management Division, the Committee on Health, Education, Labor, Office of Policy, Economics, and Innovation, and Pensions. sent, and referred as indicated: Environmental Protection Agency, transmit- EC–4136. A communication from the Chair- By Mr. SPECTER: ting, pursuant to law, the report of a rule en- man, Securities and Exchange Commission, S. 2918. A bill to make improvements to titled ‘‘Approval and Promulgation of Air transmitting, pursuant to law, a report rel- certain loan programs under the Small Busi- Quality Implementation Plans; Virginia; Up- ative to the inventory of activities for fiscal ness Act and the Small Business Investment date to Materials Incorporated by Reference; year 2009 under the FAIR Act; to the Com- Act of 1958, and for other purposes; to the Correction’’ (FRL No. 9093–6) received in the mittee on Homeland Security and Govern- Committee on Banking, Housing, and Urban Office of the President of the Senate on De- mental Affairs. Affairs. cember 15, 2009; to the Committee on Envi- EC–4137. A communication from the In- By Mr. UDALL of Colorado (for him- ronment and Public Works. spector General, General Services Adminis- self, Mr. SCHUMER, Mr. LIEBERMAN,

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Ms. SNOWE, Mrs. BOXER, Ms. COLLINS, BEGICH) was added as a cosponsor of S. Small businesses are the engine of and Mrs. GILLIBRAND): 1798, a bill to provide for the automatic economic growth in this country, re- S. 2919. A bill to amend the Federal Credit enrollment of demobilizing members of sponsible for 60 percent of new jobs cre- Union Act to advance the ability of credit the National Guard and Reserve in ated. The Commonwealth of Pennsyl- unions to promote small business growth and vania alone has 978,831 small busi- economic development opportunities, and for health care and dental care programs other purposes; to the Committee on Bank- of the Department of Veterans Affairs, nesses, which bring economic opportu- ing, Housing, and Urban Affairs. and for other purposes. nities to diverse groups of people, inno- By Mr. LAUTENBERG (for himself and S. 1810 vate new technologies, and provide val- Mr. UDALL of New Mexico): At the request of Mr. HARKIN, the uable services to their communities. Of S. 2920. A bill to amend chapter 1 of title name of the Senator from Illinois (Mr. these small businesses, 236,775 are 23, United States Code, to condition the re- DURBIN) was added as a cosponsor of S. small employers who represent 98.4 per- ceipt of certain highway funding by States 1810, a bill to direct the Secretary of cent of Pennsylvania’s employers and on the enactment and enforcement by States 49.9 percent of its private-sector em- of certain laws to prevent repeat intoxicated Health and Human Services to publish physical activity guidelines for the ployment. It is not an understatement driving; to the Committee on Environment to say that small businesses and their and Public Works. general public, and for other purposes. By Mrs. FEINSTEIN: S. 2736 ability to grow are vital to the health S. 2921. A bill to provide for the conserva- At the request of Mr. FRANKEN, the of Pennsylvania and of the Nation. tion, enhanced recreation opportunities, and name of the Senator from Colorado Earlier this month, the Labor De- partment released jobs figures indi- development of renewable energy in the Cali- (Mr. BENNET) was added as a cosponsor fornia Desert Conservation Area, to require of S. 2736, a bill to reduce the rape kit cating that unemployment has dropped the Secretary of the Interior to designate backlog and for other purposes. from 10.2 percent in October to 10 per- certain offices to serve as Renewable Energy cent in November, and that the econ- S. 2781 Coordination Offices for coordination of Fed- omy shed only 11,000 jobs, which was At the request of Ms. MIKULSKI, the eral permits for renewable energy projects well below analysts’ expectations. names of the Senator from New York and transmission lines to integrate renew- While these numbers are encouraging, able energy development, and for other pur- (Mrs. GILLIBRAND), the Senator from leading economists such as Joseph poses; to the Committee on Energy and Nat- Minnesota (Ms. KLOBUCHAR), the Sen- Stiglitz have stated that recovery will ural Resources. ator from Michigan (Ms. STABENOW) be slow unless we continue to take and the Senator from North Carolina f strong measures. (Mrs. HAGAN) were added as cosponsors When I voted for the stimulus, we SUBMISSION OF CONCURRENT AND of S. 2781, a bill to change references in SENATE RESOLUTIONS were facing a recession that could well Federal law to mental retardation to have developed into a full-fledged de- The following concurrent resolutions references to an intellectual disability, pression like we faced in 1929. The and Senate resolutions were read, and and to change references to a mentally stimulus provided $630 million to the referred (or acted upon), as indicated: retarded individual to references to an Small Business Administration, SBA, By Mrs. FEINSTEIN (for herself, Mr. individual with an intellectual dis- to guarantee private sector loans to CORNYN, Mr. CARDIN, and Mr. BROWN- ability. small businesses, which allowed the BACK): S. 2796 S. Res. 382. A resolution supporting the SBA to raise its loan caps, and in- At the request of Mr. BARRASSO, his goals and ideals of observing the National creased SBA guarantees from 75–80 per- Slavery and Trafficking Prevention Month name was added as a cosponsor of S. cent to 90 percent in its two major from January 1 through February 1, 2010, to 2796, a bill to extend the authority of business loan programs. These provi- raise awareness of, and opposition to, mod- the Secretary of Education to purchase sions have proven effective in pro- ern slavery; considered and agreed to. guaranteed student loans for an addi- viding credit to small business, but By Mr. MCCAIN (for himself, Mr. tional year, and for other purposes. more needs to be done. My legislation KERRY, Mrs. LINCOLN, Mr. INOUYE, S. 2917 permanently increases the loan limit Mr. BEGICH, Mr. FEINGOLD, Mr. SPEC- At the request of Mr. BAUCUS, the from $2 million to $5 million on 7(a) TER, Mr. GRASSLEY, Mr. BURR, Ms. name of the Senator from Indiana (Mr. COLLINS, Ms. MURKOWSKI, and Mr. loans, from $1.5 million to $5.5 million BAYH) was added as a cosponsor of S. COCHRAN): on 504 loans, and from $35,000 to $50,000 S. Res. 383. A resolution designating Janu- 2917, a bill to amend the Internal Rev- on microloans. ary 2010 as ‘‘National Mentoring Month’’; enue Code of 1986 to modify the penalty Simply raising loan limits is not considered and agreed to. for failure to disclose certain report- enough, however. Raising the SBA’s f able transactions and the penalty for guarantee will increase commercial submitting a bad check to the Internal lenders’ willingness to provide loans ADDITIONAL COSPONSORS Revenue Service, to modify certain because it reduces the risk undertaken S. 583 rules relating to Federal vendors, and by lenders. My legislation raises the At the request of Mr. PRYOR, the for other purposes. maximum loan guarantee percentage name of the Senator from Louisiana f to 97.5 percent, which will quickly and (Ms. LANDRIEU) was added as a cospon- efficiently incentivize the existing net- STATEMENTS ON INTRODUCED work of financial institutions to make sor of S. 583, a bill to provide grants BILLS AND JOINT RESOLUTIONS and loan guarantees for the develop- affordable loans to small business. Ad- ment and construction of science parks By Mr. SPECTER: ditionally, my legislation extends the S. 2918. A bill to make improvements to promote the clustering of innova- waivers for the 7(a) borrower fees and to certain loan programs under the tion through high technology activi- the 504 borrower and bank fees, which Small Business Act and the Small ties. were enacted as part of the stimulus Business Investment Act of 1958, and package, until 2011. S. 619 for other purposes; to the Committee Finally, my legislation authorizes At the request of Mr. MENENDEZ, his on Banking, Housing, and Urban Af- the SBA to declare certain commu- name was added as a cosponsor of S. fairs. nities ‘‘economic disaster areas’’ and to 619, a bill to amend the Federal Food, Mr. SPECTER. Mr. President, I have provide further assistance to small Drug, and Cosmetic Act to preserve the sought recognition to introduce the businesses within these areas. The eco- effectiveness of medically important Helping Small Business Succeed Act of nomic situation in many towns across antibiotics used in the treatment of 2009. My legislation will make it easier America has risen to emergency levels. human and animal diseases. for small businesses to access credit, Unemployment in some counties in S. 1798 credit which they desperately need to Pennsylvania has risen as high as 12 At the request of Mr. SANDERS, the be able to cover their costs, grow their and 14 percent. My legislation will pro- name of the Senator from Alaska (Mr. businesses, and create jobs. vide the SBA with greater flexibility to

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00062 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32968 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 use its funds to target areas of the hunters, cattle ranchers, mining inter- Hundreds of thousands of acres of pri- country where the level of unemploy- ests, the Department of Defense, wind vately owned land has been donated to ment exceeds the national level and and solar energy companies, Califor- or acquired by the Federal Govern- where small businesses have been hit nia’s public utility companies, and ment. the hardest. many others. I am grateful for all of Yet even as these issues were re- According to the October 2009 Special their efforts. solved, new challenges have emerged. Inspector General Report to Congress, The bill is divided into two titles. There are now competing demands over taxpayers have seen $73 billion in The first title primarily covers con- how best to manage hundreds of thou- TARP funds returned so far with a 10 servation, recreation, and other pur- sands of acres of public lands in the percent return on their investment. As poses. desert. of September 30, 2009, $9.5 billion in in- The second title of the bill covers re- Some believe the lands should be terest, dividends, and other income has newable energy development on suit- used for large-scale solar and wind fa- had been received by the federal gov- able lands. cilities and transmission lines. Others ernment. My legislation uses this rev- Taken together, this bill will shape would like to conserve critical habitat the future of the Southern California enue, derived from investments made for threatened and endangered species. Desert, and I believe it can serve as a through TARP, to pay for these ur- Some would like more acreage avail- model for future efforts to balance re- gently needed adjustments. able for grazing or for off-road recre- newable energy development and con- Small businesses need access to cred- ation. servation. Finally, some would like to see addi- it and they need it now more than ever, As of today, this bill has been en- tional lands made available for mili- if they are to weather current eco- dorsed by: the California Wilderness tary training and base expansion. nomic conditions. I look forward to Coalition; the Wildlands Conservancy; Earlier this year, I learned that BLM working with my colleagues to provide the Wilderness Society; the National had accepted applications to build vast further assistance to the small busi- Parks Conservation Association; solar and wind energy projects on ness community and to help restore Friends of the River; Cogentrix Energy; former railroad lands previously owned their ability to create jobs and stimu- Edison International, parent company by the Catellus Corporation. These late our economy. of Southern California Edison; Friends lands had been donated to the Federal Government or acquired with taxpayer By Mrs. FEINSTEIN: of Big Morongo Canyon Preserve; S. 2921. A bill to provide for the con- Friends of the Desert Mountains; Mo- funds for conservation. I believe the development of these servation, enhanced recreation oppor- jave Desert Land Trust; Desert Protec- new cleaner energy sources is vital to tunities, and development of renewable tive Council; Amargosa Conservancy; addressing climate change, yet we energy in the California Desert Con- Death Valley Conservancy; the Cities must be careful about selecting where servation Area, to require the Sec- of Barstow, Desert Hot Springs, these facilities are located. The cur- retary of the Interior to designate cer- Hesperia, Indio, Palm Springs, San rent process doesn’t work because it al- tain offices to serve as Renewable En- Bernardino and Yucaipa; Riverside lows energy firms to propose the sites ergy Coordination Offices for coordina- County Supervisor Marion Ashley; San for renewable energy development, in- tion of Federal permits for renewable Bernardino County Supervisor Neil cluding land donated or acquired spe- energy projects and transmission lines Derry; Imperial County Supervisor Wally Leimgruber; Coachella Valley cifically for conservation. to integrate renewable energy develop- Approximately $45 million of private ment, and for other purposes; to the Association of Governments; SummerTree Institute; and Route 66 donations—including a $5 million land Committee on Energy and Natural Re- discount from Catellus Corporation— sources. Preservation Foundation. The California Desert Protection and $18 million in Federal Land and Mrs. FEINSTEIN. Mr. President, I Water Conservation grants was spent rise today to introduce the California Act, which was enacted in 1994, was a sweeping piece of legislation aimed at to purchase these lands, with the in- Desert Protection Act of 2010. tent of conserving them in perpetuity. I strongly believe that conservation, conserving some of the most beautiful and ecologically significant lands in As the sponsor of the legislative pro- renewable energy development, and visions that helped secure the deal to recreation can and must coexist in the my home State. The law created Death Valley Na- acquire the roughly 600,000 acres of California Desert—and this legislation tional Park, Joshua Tree National former private land, I found the BLM’s strikes a carefully conceived balance Park and the Mojave National Pre- actions unacceptable. between these sometimes competing serve, as well as 69 desert wilderness We have an obligation to honor our concerns. areas managed by the Bureau of Land commitment to conserve these lands— The key provisions of this bill would Management, BLM. and I believe we can still accomplish designate two new national monu- Collectively, it protected over 7 mil- that goal while also fulfilling Califor- ments—the Mojave Trails and the Sand lion acres of desert lands, making it nia’s commitment to develop a clean to Snow National Monuments. the largest land conservation bill in energy portfolio. It would add adjacent lands to the the lower 48 States in U.S. history. That is the purpose of this legisla- Joshua Tree and Death Valley National To this day, it remains one of my tion. Parks and the Mojave National Pre- proudest accomplishments since join- The first title of the legislation is serve; designate 5 new BLM wilderness ing this body. geared towards the goal of conserving areas and protect 4 important water- Much has changed since the passage the Desert’s sensitive ecosystem. ways, such as the Amargosa River and of the California Desert Protection First, this bill will ensure that hun- Deep Creek, as Wild and Scenic Rivers; Act. Many of the impediments that dreds of thousands of acres of land do- improve the process to permit large- prevented conservation of other pris- nated to the federal government for scale wind and solar development on tine desert lands in the area no longer conservation will be protected by cre- suitable public and private lands in the exist. ating the Mojave Trails National California desert; and enhance rec- Department of Defense concerns with Monument. This new monument would reational opportunities in the desert, designating some wilderness areas near cover approximately 941,000 acres of while ensuring that the training needs Fort Irwin have been resolved. Federal land, which includes approxi- of the military are met. Many mining areas inside national mately 266,000 acres of the former This bill is the product of pains- parks and potential wilderness have Catellus-owned railroad lands along taking discussions with key stake- closed. historic Route 66. I visited the area holders—including environmental Grazing allotments on both BLM and earlier this year and was amazed by groups, local and State government, National Park Service land have been the beauty of the massive valleys, pris- off-highway recreation enthusiasts, retired by willing sellers. tine dry lakes, and rugged mountains.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00063 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32969 In addition to its iconic sweeping water Canyon, the BLM and U.S. For- highway vehicle use on designated desert vistas and majestic mountain est Service San Gorgonio Wilderness, routes. ranges, this area of the Eastern Mojave the Wildlands Conservancy’s Pipe’s Fourth, this bill would create the also contains critical wildlife corridors Canyon and Mission Creek Preserves, Vinagre Wash Special Management linking Joshua Tree National Park and and additional public and private con- Area. the Mojave National Preserve. It also servation lands, including two wildlife The agreed-upon designation for this encompasses hundreds of thousands of movement corridor areas connecting area in Imperial County, near the Colo- acres designated as areas of critical en- the Peninsular Ranges with the Trans- rado River, was reached after careful vironmental concern, critical habitat verse Ranges. discussion with key stakeholders. for the threatened desert tortoise, and This area is truly remarkable, and Although the land possesses some ancient lava bed flows and craters. It is would arguably be the most environ- wilderness characteristics, there are surrounded by more than a dozen BLM mentally diverse national monument also competing interests. The Navy wilderness areas. in the country. It serves as the inter- Seals currently use some of this area The BLM would be given the author- section of three converging ecological for occasional training. Additionally, ity to both conserve the monument systems—the Mojave Desert, the Colo- many local residents enjoy touring the lands, and also to maintain existing rado Desert, and the San Bernardino rolling hills in the area by jeep. recreational uses, including hunting, mountains—and is one of the most im- Through the combined efforts of con- vehicular travel on open roads and portant wildlife corridors in Southern servation groups, local residents and trails, camping, horseback riding and California. county government, and the Depart- rockhounding. This monument designation would ment of Defense, a compromise con- The bill also creates an advisory protect 23.6 miles of the Pacific Crest servation designation was developed. committee to help develop and oversee Trail and the habitat for approxi- For the land known as the Vinagre the implementation of the monument mately 240 species of migrating and Wash, the bill will create a ‘‘special management plan. It would be com- breeding birds, the second highest den- management area’’ covering 76,000 prised of representatives from local, sity of nesting birds in the U.S. It also acres, including 12,000 acres of former State and Federal Government, con- serves as a home and a crucial migra- railroad lands donated to the Federal servation and recreation groups, and tion corridor for animals traveling be- Government. local Native American tribes. tween Joshua Tree National Park, the Of these, 49,000 acres are designated Before I go on to the other conserva- oasis at Big Morongo, and the higher as potential wilderness and only be- tion provisions in the bill, I would like elevations of the San Bernardino come permanent wilderness if and to address one important issue—and Mountains. when the Department of Defense deter- that is what should be done about some I would like to make one additional mines these lands are no longer needed of the proposed renewable energy de- point, and that is that despite its eco- for Navy Seal training. velopment projects proposed for lands logical significance, this area is not This designation will permit the area included in this monument. particularly well-known—largely be- to continue to be accessed by vehicles Although it is true that the monu- cause it is managed by a number of dis- and be used for camping, hiking, moun- ment will prevent further consider- tinct entities, including the BLM, For- tain biking, sightseeing, and off-high- ation of some applications to develop est Service, National Park Service and way vehicle use on designated routes solar and wind energy projects on private preserves and conservation and protect tribal cultural assets in former Catellus lands or adjoining agencies. So, the monument designa- the area. lands in the monument, it is important tion would help to attract more atten- Fifth, the bill adds to or designates to note that of the proposals in ques- tion to one of California’s natural four new Wild and Scenic Rivers, total- tion, not a single one has been granted gems. ing 76 miles in length. This designation a permit nor is a single one under re- Third, the bill establishes new wil- will ensure they remain clean and free- view at the California Energy Commis- derness and allows more appropriate flowing and that their immediate envi- sion or under formal NEPA, National use of lands currently designated as ronments are preserved. These beau- Environmental Policy Act, review at Wilderness Study Areas. tiful waterways are Deep Creek and the BLM. The 1994 California Desert Protection Whitewater River in and near the San To ensure that creation of the monu- Act extended wilderness protection to Bernardino National Forest, as well as ment does not unnecessarily harm the many areas in the desert, yet several the Amargosa River and Surprise Can- firms that worked in good faith and in- areas near Fort Irwin were designated yon Creek near Death Valley National vested substantial time and resources as wilderness study areas in order to Park. to produce renewable energy in Cali- allow the base to expand. Sixth, the bill includes adds approxi- fornia, the legislation will offer these Now that Fort Irwin’s expansion is mately 74,000 acres of adjacent lands to companies an opportunity to relocate complete, it is time to consider these the three National Parks established their projects to federal renewable en- areas for permanent wilderness des- by the 1994 California Desert Protec- ergy zones currently being developed ignation. tion Act. by the Department of the Interior. The bill protects approximately The bill adds 41,000 acres in Death Additionally, the monument would 250,000 acres of BLM land as wilderness Valley National Park. This includes not prevent the construction or expan- in five areas. These areas contain some former mining areas where the claims sion of necessary transmission lines of the most pristine and rugged land- have been retired and a narrow strip of critical to linking renewable energy scapes in the California desert. BLM land between National Park and generation facilities with the elec- Beyond Fort Irwin, the bill also ex- Defense Department boundaries that tricity grid. pands wilderness areas in Death Valley has made BLM management difficult. Second, the bill would establish the National Park, 90,000 acres, and the The bill adds 30,000 acres in the Mo- ‘‘Sand to Snow National Monument,’’ San Bernardino National Forest, 4,300 jave National Preserve. This land was encompassing 134,000 acres of land from acres, inside the Sand to Snow Na- not included in the original Monument the desert floor in the Coachella Valley tional Monument created by this bill. because of the former Viceroy gold up to the top of Mount San Gorgonio, The bill also releases 126,000 acres of mine. However, the mining operations the highest peak in Southern Cali- land from their existing wilderness ceased several years ago, and the rec- fornia. study area designation in response to lamation process is nearly complete. The boundaries of this second, small- requests from local government and Additionally, a 2007 analysis by the In- er new monument would include two recreation users. This will allow the terior Department recommended that Areas of Critical Environmental Con- land to be made available for other this area would be suitable to add to cern: Big Morongo Canyon and White- purposes, including recreational off- the Preserve.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00064 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32970 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 The bill adds 2,900 acres in Joshua permanent OHV areas, providing off- the public interest, but comparable Tree National Park. This includes mul- highway groups some certainty that lands would have to be purchased and tiple small parcels of BLM land identi- these uses will be protected as much as donated to the Federal Government as fied for disposal on its periphery. conservation areas. Collectively, these mitigation for lost acreage. Transferring this land to the Park areas could be as much as 314,000 acres, So, all of these provisions, when Service would help protect Joshua Tree depending on what, if any, of Johnson taken together, would serve to com- by preserving these undeveloped areas Valley is ultimately needed by the Ma- plement the lasting conservation es- that border residential communities. rines. tablished by the California Desert Pro- Seventh, the bill designates new This section of the bill also requires tection Act—while ensuring that other lands as Off-Highway Vehicle Recre- the Secretary of the Interior to con- important local uses are maintained in ation Areas. duct a study to determine what, if any, appropriate areas. One of the key goals I have strived lands adjacent to these recreation The Mojave Desert is a spectacular for in this bill is to find balance to en- areas would be suitable for addition. national treasure worthy of protection, sure that the many different needs and This will help make up for some of the but it is also a unique national solar uses in the desert are accommodated lost acres in Johnson Valley should the resource. with the least possible conflict. Some Marines decide to expand there. The Mojave has more than 350 sunny of the most frequent visitors to the Finally, this title of the bill includes days per year; has large flat valleys desert are the off-highway recreation other key provisions that address var- and mesas; is close to major trans- enthusiasts. ious challenges and opportunities in mission lines and millions of elec- In California alone, there are over 1 the California desert, including: state tricity consumers in Southern Cali- million registered off-highway vehi- land exchanges. fornia; and lies above 4,000 feet in ele- cles, many of which can be found ex- There are currently about 370,000 vation, where the sun is strongest. ploring thousands of miles of desert acres of state lands spread across the There is no question that we need to trails or BLM designated open areas. California desert in isolated 640 acre harness the desert’s plentiful solar en- However, in order to meet military parcels. Because many of these acres ergy—but in order to do that, we need training needs, the Marine Corps is are inside national parks, wilderness, to cut through a bureaucratic backlog studying the potential expansion of the proposed monuments or conserva- of stalled permits, and ensure that de- Marine Corps Air Ground Combat Cen- tion areas, they are largely unusable. velopment occurs on the most appro- ter at Twentynine Palms into Johnson The bill seeks to remedy that problem priate lands. Valley, the largest OHV area in the by requiring the Department of the In- That is exactly what the second title country. I strongly support providing terior to develop and implement a plan of this legislation is intended to do. our troops with the best possible train- with the state to complete the ex- For too many years the promise of ing, but if the Marines need to expand change of these lands for other BLM or utilizing desert lands to produce clean, the base into Johnson Valley, this GSA owned property in the next ten renewable solar power was out of could have potentially resulted in the years. These land exchanges will help reach. The up-front technology costs loss of tens of thousands of acres of were too expensive, while coal was OHV recreation lands. consolidate the state lands into larger, But over the past year I met with more usable areas that could poten- deemed to be cheap and plentiful. Major General Eugene Payne, Assist- tially provide the state with viable But the economics of solar power ant Deputy Commandant for Installa- sites for renewable energy develop- began to shift in the right direction in tions and Logistics, and Brigadier Gen- ment, off- highway vehicle recreation 2005, when Congress established a 30 eral Melvin Spiese, Commanding Gen- or other commercial purposes. percent investment tax credit for solar eral, Training and Education Com- The bill ensures the right of the De- power facilities, a provision I cham- mand, to discuss this issue, and I am partment of Defense to conduct low- pioned. I was proud to work with Sen- very grateful for their efforts to con- level overflights over wilderness, na- ator SNOWE and other members of the sider base expansion options that tional parks and national monuments. Senate Finance Committee to extend would preserve much of Johnson Valley The bill requires the Department of this tax credit through 2016 during the for recreation. the Interior to study the impact of cli- last Congress. As the result of those meetings, the mate change on California desert spe- On December 17, I introduced new Marine Corps has committed to study- cies migration, incorporate the study’s legislation with Senator MERKLEY to ing an alternative that would allow for results and recommendations into land make sure solar companies can fully a portion of Johnson Valley to be used use management plans, and consider realize the benefits of these tax incen- exclusively for military training, a the study’s findings when making deci- tives. portion exclusively for continued OHV sions granting rights of way for The other chief roadblock to devel- recreation and a third area for joint projects on public lands. oping solar in the desert has been the use. While the environmental review The bill requires the Secretary to en- broken permitting process. process must first be completed, I am sure access for tribal cultural activi- The Federal Government has failed hopeful that this option will prevail for ties within national parks, monu- to focus wind and solar development on the benefit of the Marines and rec- ments, wilderness and other areas des- appropriate lands where it can be read- reational users of Johnson Valley. ignated within the bill. It also requires ily permitted. The lesson learned from Johnson Val- the Secretary to develop a cultural re- There are currently more than 110 ley is that, despite the vast size of the sources management plan to protect a applications to develop more than California desert, there are relatively sacred tribal trail along the Colorado 42,000 megawatts of renewable energy few areas dedicated to OHV recreation, River between southern Nevada and capacity on BLM land in the California and even those areas face increasing the California-Baja border. desert. competition from other types of uses. In order to ensure that donated and Until very recently, nothing was These areas are important not only to acquired Catellus lands outside the Mo- done to evaluate these development the hundreds of thousands visitors who jave Trails National Monument are proposals. enjoy them, but also to the local econ- maintained for conservation, the bill All but a few proposals have not even omy that depends on their tourist dol- prohibits their use for development, begun the formal environmental review lars. Additionally, by protecting these mining, off-highway vehicle use, except process required by the National Envi- areas, we also protect conservation designated routes, grazing, military ronmental Policy Act, NEPA. The BLM areas by providing appropriate places training and other surface disturbing has been slow to direct development to- for OHV recreation. activities. The Secretary of the Inte- wards disturbed lands or to discourage So, this bill will designate five exist- rior is authorized to make limited ex- proposals on lands acquired for the pur- ing OHV areas in the Mojave desert as ceptions in cases where it is deemed in pose of conservation.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00065 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32971 Wind developers have had to wait develop pristine public lands, instead rently approximately 3 million acres of more than three years to receive per- of using private lands. California desert that are managed by mission to measure the wind above The answer shocked me: they told me the military, and much of this land public lands. it was easier to permit a project on could be developed for renewable en- The Fish and Wildlife Service has pristine public land than on private ergy consistent with the military mis- told renewable energy developers seek- lands. sion. ing to use disturbed private lands that We need to ensure that it takes no By requiring the military to evaluate they would need to develop complex longer to review an application to de- the impacts of a program to develop its habitat conservation plans for their velop private lands than it does to de- solar resource, the legislation ensures projects, a process expected to take velop public lands—without infringing that all available public lands are prop- nine years. upon important environmental regula- erly considered for renewable energy Contrast that with the recent an- tions. development in California. nouncement from Interior Secretary So, the bill would establish a pilot Fifth, this legislation expedites the Ken Salazar, who has pledged that the mitigation bank program—a new idea permitting of temporary meteorolog- BLM will complete permitting of 10 based on successful desert protection ical measurement devices. ‘‘fast track’’ solar projects on public efforts in Nevada, wolf protection ef- In California, it sometimes takes a lands by December 2010. forts in New Mexico, and Coral Reef wind developer three years to get a per- So, the good news is that this admin- protection efforts in the Caribbean. mit simply to measure wind speed. istration has taken steps in the right The mitigation bank program would Such barriers to research are unneces- direction to encourage this important be a win-win, both accelerating permit- sary and unwise, and this legislation shift to renewable energy. ting and coordinating endangered spe- assures that this type of research But it is critical, nonetheless, that cies protection efforts. qualifies for existing categorical exclu- this legislation is enacted in order to Developers seeking to utilize private sions from complex environmental re- codify and build upon these improve- lands would be able to contribute to a views. ments to the permitting process and mitigation fund, instead of negotiating Sixth, the legislation would provide help establish the transmission lines the terms of endangered species miti- grants and loan guarantees to innova- needed to carry cleaner energy from gation, which the Fish and Wildlife tive electricity transmission tech- the desert to consumers. Service recently predicted would take nologies that will reduce the need to Key provisions of the bill: first, the nine years. build massive, visually and environ- bill will require BLM to put personnel The interest from the funds contrib- mentally disruptive transmission lines in place focused exclusively on renew- uted by developers would be used to in the desert. able energy development in the desert, better manage endangered species Finally, the legislation would return make the staff accountable to Con- habitat in specific mitigation zones of 25 percent of the revenue generated by gress, and provide a reliable stream of federal land that would be permanently new renewable energy projects to the funding to expedite the review of appli- set aside for species protection. State, and 25 percent to local county cations. The principal in this fund would be governments. This would ensure that The BLM began establishing renew- used to purchase new pristine habitat these entities have the resources to able energy permitting offices earlier when it became available. support permitting, public lands pro- this year, but this legislation would This Mitigation bank program would tection, and local conservation efforts. codify this new administrative policy, be run by BLM, and the Fish and Wild- Bottom line: The permitting process establish that the offices have a clear life Service would consult with the is broken. It is not facilitating solar Congressional mandate, and ensure BLM on renewable energy project re- and wind development where it be- that they will focus specifically on re- view, just as they do now for renewable longs. This legislation intends to fix newable energy development in each energy proposals on public land. that. state with significant wind and solar This would help level the playing It may surprise my colleagues that I resources on public land. field between public and private lands, am introducing such comprehensive These offices would be funded from and it could cut down the time it takes legislation to ensure the protection of the existing BLM permit improvement to permit projects for private lands California’s desert heritage, the devel- fund—a fund which is currently only considerably. opment of our renewable resources, and available to supervise the permitting Fourth, the legislation would require the continued enjoyment of desert for oil and natural gas development. the BLM, the Forest Service, and the recreation. It makes sense that this fund should military to complete Environmental After all, I am not from the desert. I go towards providing cleaner energy Impact Statements to develop renew- have lived in or near San Francisco for sources as well. able energy on the lands they oversee. most of my life. Second, the bill would help cut This has two benefits. But over the years I have come to through the backlog of pending renew- First, it ensures that Federal land truly appreciate California’s sweeping able development applications with a managers will proactively plan the use desert landscapes. ‘‘use it or lose it’’ approach. of public lands—instead of allowing I remember my first visits to the This would replace the ‘‘first come- private industry to make these de facto desert years ago. It was treated like a first serve’’ approach the BLM cur- decisions. waste dump. It was full of abandoned rently employs. Federal land managers will be re- cars. Old appliances littered the land- The legislation would establish strict quired to identify renewable energy de- scape. deadlines for developers to conduct velopment areas where development is But we have worked very hard to necessary biological and cultural stud- in the public interest through the pro- clean it up. ies, ensure connection to the grid, and grammatic EIS process. This will help We have worked to make sure that develop a plan for water. This would avoid the sort of site-specific environ- the vast vistas and pristine desert ensure that serious development pro- mental conflicts that can delay habitat are respected by humanity, and posals are moved to the front of the projects for years. that we give to our children a line—and help put an end to unfettered The second benefit of this provision healthier, more beautiful desert than speculation on desert lands. is that it will result in a formal evalua- we inherited. Third, this legislation will expedite tion of whether public land currently But if we are to remain successful in the application process for solar devel- managed by the military will also be the long run, we must not only protect opment on private lands. considered for solar development, in- the desert land itself, we must also pro- When I toured the desert last spring, stead of concentrating this develop- tect the broader environment from the I asked developers why they wanted to ment only on BLM land. There are cur- ravages of climate change, and we

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00066 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32972 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 must offer economic opportunity to Whereas victims of modern slavery need SENATE RESOLUTION 383—DESIG- those who live in these areas. support in order to escape and to recover NATING JANUARY 2010 AS ‘‘NA- That is the purpose of this legisla- from the physical, mental, emotional, and TIONAL MENTORING MONTH’’ tion. There are many places in the spiritual trauma associated with their vic- timization; Mr. MCCAIN (for himself, Mr. KERRY, California desert where development Mrs. LINCOLN, Mr. INOUYE, Mr. BEGICH, and employment are essential and ap- Whereas human traffickers use many phys- ical and psychological techniques to control Mr. FEINGOLD, Mr. SPECTER, Mr. propriate. their victims, including the use of violence GRASSLEY, Mr. BURR, Ms. COLLINS, Ms. But there are also places that future or threats of violence against the victim or MURKOWSKI, and Mr. COCHRAN) sub- generations will thank us for setting the victim’s family, isolation from the pub- mitted the following resolution; which aside. lic, isolation from the victim’s family and was considered and agreed to: I have worked painstakingly with religious or ethnic communities, language S. RES. 383 stakeholders to ensure that this legis- and cultural barriers, shame, control of the Whereas mentoring is a longstanding tradi- lation balances sometimes competing victim’s possessions, confiscation of pass- tion in which a dependable, caring adult pro- needs. ports and other identification documents, vides guidance, support, and encouragement This bill, if enacted, will have a posi- and threats of arrest, deportation, or impris- to facilitate a young person’s social, emo- tive and enduring impact on the land- onment if the victim attempts to reach out tional, and cognitive development; scape of the Southern California for assistance or to leave; Whereas continued research on mentoring desert, and I hope it will stand as a Whereas although laws to prosecute per- shows that formal, high-quality mentoring model for how to balance renewable en- petrators of modern slavery and to assist and focused on developing the competence and ergy development and conservation. protect victims of human trafficking, such character of the mentee promotes positive as the Trafficking Victims Protection Act of outcomes, such as improved academic f 2000 (division A of Public Law 106–386; 114 achievement, self-esteem, social skills, and SUBMITTED RESOLUTIONS Stat. 1466) and the William Wilberforce Traf- career development; ficking Victims Protection Reauthorization Whereas further research on mentoring Act of 2008 (Public Law 110–457; 122 Stat. provides strong evidence that mentoring suc- SENATE RESOLUTION 382—SUP- 5044), have been enacted in the United cessfully reduces substance use and abuse, States, awareness of the issues surrounding academic failure, and delinquency; PORTING THE GOALS AND Whereas mentoring, in addition to pre- IDEALS OF OBSERVING THE NA- slavery and trafficking by those people most likely to come into contact with victims is paring young people for school, work, and TIONAL SLAVERY AND TRAF- life, is extremely rewarding for those serving essential for effective enforcement because FICKING PREVENTION MONTH as mentors; the techniques that traffickers use to keep FROM JANUARY 1 THROUGH Whereas more than 4,700 mentoring pro- their victims enslaved severely limit self-re- FEBRUARY 1, 2010, TO RAISE grams in communities of all sizes across the porting; United States focus on building strong, effec- AWARENESS OF, AND OPPOSI- Whereas January 1 is the anniversary of TION TO MODERN SLAVERY tive relationships between mentors and the effective date of the Emancipation Proc- mentees; Mrs. FEINSTEIN (for herself, Mr. lamation; Whereas approximately 3,000,000 young CORNYN, Mr. CARDIN, and Mr. BROWN- Whereas February 1 is the anniversary of people in the United States are in solid men- BACK) submitted the following resolu- the date that President Abraham Lincoln toring relationships due to the remarkable tion; which was considered and agreed signed the joint resolution sending the 13th vigor, creativity, and resourcefulness of the to: Amendment to the States for ratification, to thousands of mentoring programs in commu- forever declare that ‘‘Neither slavery nor in- nities throughout the Nation; S. RES. 382 voluntary servitude . . . shall exist within the Whereas in spite of the progress made to Whereas the United States has a tradition United States, or any place subject to their increase mentoring, the United States has a of advancing fundamental human rights, jurisdiction’’ and is a date which has long serious ‘‘mentoring gap’’, with nearly having abolished the Transatlantic Slave been celebrated as National Freedom Day, as 15,000,000 young people in need of mentors; Trade in 1808 and having abolished chattel described in section 124 of title 36, United Whereas mentoring partnerships between slavery and prohibited involuntary servitude States Code; the public and private sectors bring State in 1865; Whereas, under its authority to enforce the and local leaders together to support men- Whereas because the people of the United 13th Amendment ‘‘by appropriate legisla- toring programs by preventing duplication of States remain committed to protecting indi- efforts, offering training in industry best tion,’’ Congress in the Trafficking Victims vidual freedom, there is a national impera- practices, and making the most of limited Protection Act of 2000 updated the post-Civil tive to eliminate human trafficking, which resources to benefit young people in the War involuntary servitude and slavery stat- is the recruitment, harboring, transpor- United States; tation, provision, or obtaining of persons for utes and adopted an approach known as the Whereas the designation of January 2010 as labor or services through the use of force, ‘‘3P’’ approach of victim protection, vigorous ‘‘National Mentoring Month’’ will help call fraud, or coercion for the purpose of subjec- prosecution, and prevention of human traf- attention to the critical role mentors play in tion to involuntary servitude, peonage, debt ficking; and helping young people realize their potential; bondage, or slavery, and the inducement of a Whereas the effort by individuals, busi- Whereas a month-long celebration of men- commercial sex act by force, fraud, or coer- nesses, organizations, and governing bodies toring will encourage more individuals and cion, or in which the person induced to per- to commemorate January 11 as Human Traf- organizations, including schools, businesses, form such act has not attained 18 years of ficking Awareness Day represents one of the nonprofit organizations, faith institutions, age; many positive examples of the commitment and foundations, to become engaged in men- Whereas to combat human trafficking in in the United States to raise awareness of toring across the United States; and the United States and globally, the people of and to actively oppose modern slavery: Now, Whereas National Mentoring Month will, the United States, the Federal Government, therefore, be it most significantly, build awareness of men- and State and local governments must be toring and encourage more people to become That the Senate supports— aware of the realities of human trafficking Resolved, mentors and help close the mentoring gap in and must be dedicated to stopping this con- (1) the goals and ideals of observing the the United States: Now, therefore, be it temporary manifestation of slavery; National Slavery and Trafficking Prevention Resolved, That the Senate— Whereas beyond all differences of race, Month from January 1 through February 1, (1) designates the month of January 2010 as creed, or political persuasion, the people of 2010, to recognize the vital role that the peo- ‘‘National Mentoring Month’’; the United States face national threats to- ple of the United States have in ending mod- (2) recognizes with gratitude the contribu- gether and refuse to let modern slavery exist ern slavery; tions of the millions of caring adults and in the United States and around the world; (2) marking this observance with appro- students who are already volunteering as Whereas the United States should actively priate programs and activities culminating mentors and encourages more adults and oppose all individuals, groups, organizations, in the observance on February 1 of National students to volunteer as mentors; and and nations who support, advance, or com- Freedom Day, as described in section 124 of (3) encourages the people of the United mit acts of human trafficking; title 36, United States Code; and States to observe National Mentoring Month Whereas the United States must also work (3) all other efforts to raise awareness of with appropriate ceremonies and activities to end slavery in all of its forms around the and opposition to human trafficking. that promote awareness of, and volunteer in- world through education; volvement with, youth mentoring.

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00067 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32973 PRIVILEGES OF THE FLOOR In addition, it recognizes that Janu- ily’s children through false promises of Mr. BAUCUS. Mr. President, I ask ary 11 is a day that many have chosen pay. The victim was eventually able to unanimous consent that Daniel to commemorate human trafficking. In escape, with the assistance of local Barlava, an intern in Senator DODD’s the 110th Congress, I sponsored a con- residents and officials and parents at a office, be granted the privilege of the current resolution that passed the Sen- local elementary school. floor for the remainder of today’s ses- ate supporting January 11 as a Na- Human trafficking is a pervasive sion. tional Day of Human Trafficking global crime, with nearly 1 million peo- The PRESIDING OFFICER. Without Awareness. ple trafficked across international bor- objection, it is so ordered. In 2007, California passed a resolu- ders every year. According to the State Department, roughly 80 percent of the f tion, signed into law by Governor Schwarzenegger, designating January victims are women and children. SUPPORTING NATIONAL SLAVERY 11 as National Day of Human Traf- I believe that it is vital that we work AND TRAFFICKING PREVENTION ficking Awareness. The Los Angeles together as a nation to eliminate MONTH City Council and the Los Angeles human trafficking and prevent the vic- Mr. DURBIN. I ask unanimous con- County Board of Supervisors did the timization of the most vulnerable sent that the Senate proceed to the im- same for the county of Los Angeles. members of society. mediate consideration of S. Res. 382 The issue of human trafficking has Awareness of the issues surrounding submitted earlier today. become particularly problematic in slavery and trafficking by those people most likely to come into contact with The PRESIDING OFFICER. The California. San Diego is an inter- vulnerable populations is essential for clerk will report the resolution by national trafficking gateway city used effective prevention and prosecution of title. to traffic foreign children into the U.S. The bill clerk read as follows: this frequently hidden crime. The United Nations has listed Mexico I thank my colleagues for their sup- A resolution (S. Res. 382) supporting the as the No. 1 exporter of exploited chil- goals and ideals of observing National Slav- port of this resolution to help raise dren into North America. awareness of modern day slavery. ery and Trafficking Prevention Month from From 1998 to 2003, more than 500 peo- January 1 through February 1, 2010, to raise Mr. DURBIN. I ask unanimous con- awareness of, and opposition to, modern ple from 18 countries were ensnared in sent that the resolution be agreed to, slavery. 57 forced labor operations throughout the preamble be agreed to, the motions There being no objection, the Senate California. These statistics only rep- to reconsider be laid upon the table, proceeded to consider the resolution. resent the cases that were discovered. with no intervening action or debate, Mrs. FEINSTEIN. Mr. President, Frequently, human trafficking goes un- and any statements related to the reso- today the Senate will take an impor- detected because the victims are not lution be printed in the RECORD at the tant step to raise awareness of human only afraid of their traffickers, but appropriate place. trafficking, a form of modern-day slav- they have been taught by their traf- The PRESIDING OFFICER. Without ery. The resolution, introduced by my- fickers to fear U.S. law enforcement. objection, it is so ordered. self and Senators CORNYN, CARDIN, and Congress has acted to broaden the The resolution (S. Res. 382) was BROWNBACK, observes National Slavery tools available to prosecute perpetra- agreed to. and Trafficking Prevention Month tors of modern slavery and to assist The preamble was agreed to. from January 1 through February 1 to and protect victims of human traf- The resolution, with its preamble, raise awareness of, and opposition to, ficking. It has enacted the Trafficking reads as follows: modern slavery and human trafficking. Victims Protection Act of 2000 and the S. RES. 382 This bipartisan resolution was passed William Wilberforce Trafficking Vic- Whereas the United States has a tradition unanimously today by the Senate. tims Protection Reauthorization Act of of advancing fundamental human rights, Human trafficking is a crime in 2008. having abolished the Transatlantic Slave which persons are forced to work California has taken a leadership role Trade in 1808 and having abolished chattel against their will in sweatshops, pros- in identifying and prosecuting human slavery and prohibited involuntary servitude trafficking cases. For example, San in 1865; titution rings, farm labor, private Whereas because the people of the United homes, and other enterprises. The traf- Diego received one of the first grants States remain committed to protecting indi- fickers use force, threats of force, and to train local law enforcement on iden- vidual freedom, there is a national impera- coercion to ensure that their victims tifying and prosecuting human traf- tive to eliminate human trafficking, which believe they have no other choice but ficking. The U.S. attorneys offices in is the recruitment, harboring, transpor- to work for their captors. Oakland, Los Angeles, and San Diego tation, provision, or obtaining of persons for The resolution resolves that Congress have all created antitrafficking task labor or services through the use of force, supports (1) the goals and ideals of ob- forces. fraud, or coercion for the purpose of subjec- serving the National Slavery and Traf- Using these tools, this August five tion to involuntary servitude, peonage, debt bondage, or slavery, and the inducement of a ficking Prevention Month from Janu- people in California were sentenced to commercial sex act by force, fraud, or coer- ary 1 through February 1 to recognize Federal prison, all receiving multi- cion, or in which the person induced to per- the vital role that the people of the decade sentences for their roles in an form such act has not attained 18 years of United States have in ending modern international sex trafficking ring that age; slavery; (2) marking this observance lured young Guatemalan women and Whereas to combat human trafficking in with appropriate programs and activi- girls into the Los Angeles area and the United States and globally, the people of ties culminating in the observance on forced them into prostitution. the United States, the Federal Government, February 1 of National Freedom Day; In this distressing case, the defend- and State and local governments must be ants intimidated and controlled their aware of the realities of human trafficking and (3) all other efforts to raise aware- and must be dedicated to stopping this con- ness of and opposition to human traf- victims by threatening to beat them temporary manifestation of slavery; ficking. and kill their loved ones in Guatemala Whereas beyond all differences of race, This resolution recognizes the month if they tried to escape. At least three of creed, or political persuasion, the people of of January as significant for modern the defendants restrained the victims the United States face national threats to- slavery and human trafficking. Janu- by locking them in at night and block- gether and refuse to let modern slavery exist ary 1 is the anniversary of the effective ing windows and doors to prevent their in the United States and around the world; date of the Emancipation Proclama- escape. Whereas the United States should actively tion and February 1 is the anniversary In another recent case in Walnut oppose all individuals, groups, organizations, and nations who support, advance, or com- of the date that President Abraham Creek, CA, a woman was found guilty mit acts of human trafficking; Lincoln signed the joint resolution of trafficking a nanny from Peru. For Whereas the United States must also work sending the 13th amendment to the nearly 2 years, the victim was forced to to end slavery in all of its forms around the States for ratification. cook, clean, and take care of the fam- world through education;

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00068 Fmt 0686 Sfmt 0634 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with 32974 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 December 21, 2009 Whereas victims of modern slavery need mediate consideration of S. Res. 383 The PRESIDING OFFICER. Without support in order to escape and to recover submitted earlier today. objection, it is so ordered. from the physical, mental, emotional, and The PRESIDING OFFICER. The The resolution (S. Res. 383) was spiritual trauma associated with their vic- clerk will report the resolution by timization; agreed to. Whereas human traffickers use many phys- title. ical and psychological techniques to control The bill clerk read as follows: The preamble was agreed to. their victims, including the use of violence A resolution (S. Res. 383) designating Janu- The resolution, with its preamble, ary 2010 as ‘‘National Mentoring Month.’’ or threats of violence against the victim or reads as follows: the victim’s family, isolation from the pub- There being no objection, the Senate lic, isolation from the victim’s family and proceeded to consider the resolution. S. RES. 383 religious or ethnic communities, language Mr. McCAIN. Mr. President, I am Whereas mentoring is a longstanding tradi- and cultural barriers, shame, control of the pleased today to join many of my col- tion in which a dependable, caring adult pro- victim’s possessions, confiscation of pass- vides guidance, support, and encouragement ports and other identification documents, leagues in supporting a resolution des- to facilitate a young person’s social, emo- and threats of arrest, deportation, or impris- ignating January 2010 as ‘‘National onment if the victim attempts to reach out Mentoring Month.’’ tional, and cognitive development; for assistance or to leave; We all agree that young people need Whereas continued research on mentoring Whereas although laws to prosecute per- a supportive environment based on shows that formal, high-quality mentoring petrators of modern slavery and to assist and focused on developing the competence and structured and trusting relationships character of the mentee promotes positive protect victims of human trafficking, such with adults. The world is more com- as the Trafficking Victims Protection Act of outcomes, such as improved academic 2000 (division A of Public Law 106–386; 114 plicated for children today than it ever achievement, self-esteem, social skills, and Stat. 1466) and the William Wilberforce Traf- was when I was growing up. Mentors career development; ficking Victims Protection Reauthorization can help young people through the dif- Whereas further research on mentoring Act of 2008 (Public Law 110–457; 122 Stat. ficult periods, help them see the dif- provides strong evidence that mentoring suc- 5044), have been enacted in the United ference between right and wrong, al- cessfully reduces substance use and abuse, States, awareness of the issues surrounding leviate their doubts and concerns, and academic failure, and delinquency; slavery and trafficking by those people most answer their questions frankly. Men- Whereas mentoring, in addition to pre- likely to come into contact with victims is tors can dramatically impact a young paring young people for school, work, and essential for effective enforcement because life, is extremely rewarding for those serving person’s life by providing the support the techniques that traffickers use to keep as mentors; their victims enslaved severely limit self-re- and encouragement that children need Whereas more than 4,700 mentoring pro- porting; in order to grow into responsible, car- grams in communities of all sizes across the Whereas January 1 is the anniversary of ing adults. United States focus on building strong, effec- the effective date of the Emancipation Proc- This resolution recognizes the value tive relationships between mentors and lamation; of volunteering time to make a dif- mentees; Whereas February 1 is the anniversary of ference in the life of a child. A growing Whereas approximately 3,000,000 young the date that President Abraham Lincoln body of research has shown that high- people in the United States are in solid men- signed the joint resolution sending the 13th quality programs can make all the dif- toring relationships due to the remarkable Amendment to the States for ratification, to vigor, creativity, and resourcefulness of the forever declare that ‘‘Neither slavery nor in- ference and help students in need achieve the type of future they might thousands of mentoring programs in commu- voluntary servitude . . . shall exist within the nities throughout the Nation; United States, or any place subject to their never have thought possible. Children Whereas in spite of the progress made to jurisdiction’’ and is a date which has long with mentors are shown to improve in increase mentoring, the United States has a been celebrated as National Freedom Day, as school performance and attendance. serious ‘‘mentoring gap’’, with nearly described in section 124 of title 36, United Also, they are more self-confident, 15,000,000 young people in need of mentors; States Code; have good social skills, and above all Whereas mentoring partnerships between Whereas, under its authority to enforce the else, they are motivated to reach their the public and private sectors bring State 13th Amendment ‘‘by appropriate legisla- and local leaders together to support men- tion,’’ Congress in the Trafficking Victims full potential. Unfortunately, a severe toring programs by preventing duplication of Protection Act of 2000 updated the post-Civil shortage of volunteers has left over 15 efforts, offering training in industry best War involuntary servitude and slavery stat- million young people without mentors. practices, and making the most of limited utes and adopted an approach known as the National Mentoring Month high- resources to benefit young people in the ‘‘3P’’ approach of victim protection, vigorous lights the needs and goals of mentoring United States; prosecution, and prevention of human traf- in this country and honors the con- Whereas the designation of January 2010 as ficking; and tributions of the many volunteers ‘‘National Mentoring Month’’ will help call Whereas the effort by individuals, busi- across the country that are currently attention to the critical role mentors play in nesses, organizations, and governing bodies helping young people realize their potential; to commemorate January 11 as Human Traf- connecting with youth in such pro- ficking Awareness Day represents one of the grams. Next month, nonprofit organi- Whereas a month-long celebration of men- many positive examples of the commitment zations, schools, businesses, faith com- toring will encourage more individuals and in the United States to raise awareness of munities, and government agencies— organizations, including schools, businesses, and to actively oppose modern slavery: Now, led by the National Mentoring Partner- nonprofit organizations, faith institutions, and foundations, to become engaged in men- therefore, be it ship and the Harvard School of Public Resolved, That the Senate supports— toring across the United States; and Health—will join together to encourage Whereas National Mentoring Month will, (1) the goals and ideals of observing the adults to serve as mentors for our National Slavery and Trafficking Prevention most significantly, build awareness of men- Month from January 1 through February 1, young people. Programs must be ex- toring and encourage more people to become 2010, to recognize the vital role that the peo- panded to recruit more volunteers to mentors and help close the mentoring gap in ple of the United States have in ending mod- help fill the mentoring gap. Mentoring the United States: Now, therefore, be it ern slavery; has successfully helped many children Resolved, That the Senate— (2) marking this observance with appro- in this country and we must work to- (1) designates the month of January 2010 as priate programs and activities culminating gether to expand such valuable pro- ‘‘National Mentoring Month’’; in the observance on February 1 of National grams. I urge the Senate to approve (2) recognizes with gratitude the contribu- Freedom Day, as described in section 124 of this resolution. tions of the millions of caring adults and title 36, United States Code; and students who are already volunteering as (3) all other efforts to raise awareness of Mr. DURBIN. I ask unanimous con- sent that the resolution be agreed to, mentors and encourages more adults and and opposition to human trafficking. students to volunteer as mentors; and the preamble be agreed to, the motions f (3) encourages the people of the United to reconsider be laid upon the table NATIONAL MENTORING MONTH States to observe National Mentoring Month with no intervening action or debate, with appropriate ceremonies and activities Mr. DURBIN. I ask unanimous con- and any statements related to the reso- that promote awareness of, and volunteer in- sent that the Senate proceed to the im- lution be printed in the RECORD. volvement with, youth mentoring.

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Mr. President, I ask Senate which the majority leader is likely to pass based on this morning’s unanimous consent that the controlled anxious to get passed before Christmas. cloture vote, would make an time be extended for an additional 30 I suspect that he knows if this bill sees unsustainable fiscal situation even minutes under the control of the Re- too much light of day, he could lose 1 worse. publican side, and that all additional or 2 of his 60 votes, and that is why his Let me remind you as we stand right time, including that already utilized by managers’ amendment was kept under now that our Nation’s debt has exceed- Senator MENENDEZ, with postcloture wraps so that no one knew anything ed $12 trillion for the first time in our time continue to run during this pe- about it until the last minute. history. In fact, from 2008 to 2009 alone, riod. On our side of the aisle, we would the Federal debt increased 19 percent, The PRESIDING OFFICER. Without like to hold off until after Christmas to boosting national debt as a percentage objection, it is so ordered. give all Members of the Senate and the of GDP from 70 percent last year to 84 f American people a chance to review percent this year. We have not seen this legislation. Obviously, this is not this kind of debt-to-GDP ratio since ORDERS FOR TUESDAY, going to happen. I think that is unfor- the end of the Second World War. DECEMBER 22, 2003 tunate. We have amassed a staggering $70 Mr. DURBIN. I ask unanimous con- When you compare the number of trillion in unfunded obligations over sent that when the Senate completes days we spent debating this bill to the next 75 years or an estimated its business today, it stand adjourned other major pieces of legislation that $600,000 per American household. until 7 a.m., Tuesday, December 22; have come before this body in recent Our Medicare Program is already on that following the prayer and pledge, years, the Democrats’ haste is obvious. shaky footing with $37 trillion in un- the Journal of proceedings be approved For example, in 2002, I was very much funded future Medicare costs, and the to date, the morning hour be deemed involved in the legislation that created Medicare trust fund is expected to be expired, and the time for the two lead- the Department of Homeland Security. insolvent by 2017. Frankly, this is why ers be reserved for their use later in We spent 19 days over 7 weeks on the I am disappointed the Senate failed to the day; that the Senate then resume floor debating that bill. We took 20 support Senator GREGG’s amendment consideration of H.R. 3590, with votes on amendments during the de- we considered earlier in this debate to postcloture time continuing to run bate. The final result was bipartisan. ensure that the savings achieved by during the overnight adjournment, and Ninety Members of the Senate voted Medicare cuts would be used to ensure that the time until the expiration of for it. the viability of the program, and not postcloture time be equally divided and Tragically, for the American people, new entitlements. controlled between the leaders or their unlike other important health care-re- I ask my colleagues, can our Nation designees; that upon the expiration of lated bills such as the Medicare Mod- take on new programs and costs when the time, the majority leader be recog- ernization Act that garnered wide bi- we cannot pay for what we are doing nized to move to table amendment No. partisan support, this bill is nowhere right now? Our Nation’s fiscal picture 3278; that upon disposition of amend- near bipartisan and did not receive a is not pretty. Our obligations to our ment No. 3278, amendment No. 3277 be single Republican vote for cloture at 1 entitlement programs are exploding. If withdrawn; that the Senate then pro- this morning, and only one Republican we keep going the way we are, our debt ceed to vote on adoption of amendment in the House of Representatives sup- will double in 5 years and triple in 10. No. 3276; that upon disposition of ported it. Our budgets are unbalanced as far as amendment No. 3276, the Senate then In my humble opinion, the way this the eye can see. Last year we borrowed proceed to vote on the motion to in- bill was negotiated behind closed doors, $1.4 trillion, and 50 percent of our debt voke cloture on amendment No. 2786; and without the input of Members from is in the hands of foreign countries. that if cloture is invoked, the majority both sides, will sour relations and bi- The American people get it. They al- leader then be recognized and that the partisan discussion on other major ready know the Federal Government is time until 9:30 a.m. then be equally di- issues to come before the Senate, such the worst credit card abuser in the vided and controlled between the lead- as debt and deficit reduction—notably world, and we are putting everything ers or their designees; further, that the bipartisan legislation that I have been on the tab of our children and grand- Senate begin alternating one-hour working on very closely with Senators children. blocks of time beginning at 9:30 a.m. GREGG and CONRAD, a comprehensive They are not the only ones. Inter- until 5:30 p.m., with the Republicans energy bill, reauthorization of the sur- controlling the first hour; that at 12:30 nationally, our creditors are con- face transportation bill, climate cerned. Chinese Premier Wen Jiabao p.m., the Senate stand in recess until change legislation, and—very impor- 2:30 p.m., and that upon reconvening, has noted: tant—a jobs bill. We have lent a huge amount of money to the Senate resume the alternating The problems facing our country are blocks until 5:30 p.m., with all the United States and of course we’re con- too serious for business as usual, each cerned about the security of our assets and, postcloture time counting during any side one-upping the other for political to be honest, I am a little bit worried. That’s recess period and until 5:30 p.m. advantage, with the 2010 elections cast- why here I would like to urge the US to keep The PRESIDING OFFICER. Without ing shadows on what we should be its commitment and promise to ensure the objection, it is so ordered. doing for the benefit of our country, at safety of Chinese assets. f a time when this Nation is as fragile as That is what he said to the Presi- ORDER FOR ADJOURNMENT I have seen it in my entire life. dent—anybody who goes to China Mr. DURBIN. Mr. President, I ask Our future and the future of our chil- today. They are worried about the fact unanimous consent that the Senate ad- dren and grandchildren is in our hands. they have lent us a lot of money and journ following the remarks of Senator Our constituents and the world are maybe they might not get it back. While the international community VOINOVICH of Ohio and Senator watching. Our credibility and credit understands our crisis, somehow Con- DEMINT, if he chooses to speak. are on the line, and so is our economic The PRESIDING OFFICER. Without and national security, and, quite frank- gress does not get it. Here we are con- objection, it is so ordered. ly, our leadership position in the world. sidering a bill that, when fully imple- The Senator from Ohio. We need fewer partisans in this body mented, spends more than $2 trillion f and more statesmen. over 10 years to restructure our health Last week I came to the floor to re- care system. HEALTH CARE REFORM mind my colleagues and the American I respect my friends on the other side Mr. VOINOVICH. Mr. President, I people about the fiscal realities that of the aisle, but the assumptions they wanted to take some time to talk face our Nation and explained how this make are optimistic about the cuts in

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Many of them stead of dealing with its more than $200 cause. I sit, I listen patiently, and I say have to hire multiple tax attorneys and billion cost. to them: If what you are asking me to accountants to help them navigate the The bill before us does not even have do means we are going to have to bor- Federal laws and their tax obligations. the 1-year fix that the original bill had row money, and it is going to be paid I cannot help but wonder how many included. My friends on the other side for by our children and grandchildren, businesses, both large and small, will of the aisle have decided to put it off what do you have to say? Nine times have to hire new ‘‘benefit managers.’’ and deal with it in a separate measure out of 10, they say: No. Thank you very There is an area where we will create because it would make this bill even much, Senator. And they go out the some new jobs. We are going to hire more expensive. door. They get it. They understand benefit managers to help them keep As congressional observers have that. track of the new requirements to en- noted, we continue to put off the dif- Unfortunately, Congress does not get sure they are offering the appropriate ficult choices. The fact is, Congress is it. It is not just my colleagues on the benefits or paying the appropriate fine. not willing to take short-term pain for other side of the aisle, folks. No one’s What a nightmare. long-term gain. This is my 11th year, hands are completely clean. That is the No one has mentioned the thousands and it is the same old story year after way it is. We just keep on going the of additional Federal workers. Nobody year. way we are, keep going down the road. has talked about it. When we did Part This brings me back to the health Here we are in the worst recession D of Medicare, they had to hire over 500 care bill. I have heard all the argu- since the Great Depression. Millions of people at CMS. So we will have to hire ments of why health care reform is Americans are out of work. Others all kinds of people, including—listen to needed, and—do you know something— lucky enough to have a job are won- this—at the Internal Revenue Service. I agree with most of them. Frankly, dering if they will be next to be laid off I bet you would have a hard time find- there are a number of incremental or fired. In my State of Ohio, the un- ing an American who thinks it is a things we could do today to make real employment rate is 10.6 percent. Yet good idea to get the IRS involved in de- improvements in our system in a bipar- we are talking about health care re- livering our Nation’s health care. tisan way. In fact, I encourage my col- form, cap and trade, which will put The worst thing we can do is borrow leagues to take a look at some of the unsustainable burdens on doing busi- another $2.3 trillion, create additional proposals contained in the alternatives ness in this country and make it more Federal programs, and put a bigger offered by my colleagues, including difficult to get this economy going burden on the engine of job creation. I Senators WYDEN and BENNETT. again. find this especially troublesome after These and other legislative proposals What people in this country want is hearing the Chief Actuary at the Cen- include things we can do on an incre- to go back to work and have some as- ters for Medicare & Medicaid Services mental basis to improve our system, surance that their jobs are safe. The last week report that under the origi- such as making it easier for small busi- best way to give them security and ac- nal Reid health care bill costs would go ness to group together to reduce their cess to health insurance is to get them up, not down. In fact, according to his health care costs; passing medical li- back to work. analysis, the Federal Government ability reform, where we have more We should not be asking our Nation’s would spend $234 billion more on health tests being taken because doctors are businesses to take on new tax burdens care if this legislation became law than afraid of being sued; increasing flexi- in the current recession. Yet this bill without it—$234 billion more with this bility in the private market so people before us would impose $28 billion in legislation than what we are spending have more options and can choose in- new taxes on employers—$28 billion. right now. surance products that best meet their Furthermore, the legislation creates a It is not just the Federal Govern- needs; implementing policies that en- new Medicare payroll tax that will ment. As I discussed in some detail last courage wellness and prevention; elimi- likely hit approximately one-third of week, most States will have new fiscal nating the fraud and abuse that have the small businesses in this country, obligations of about $26 billion under and will continue to plague our public which employ some 30 million Ameri- this bill. If you are not lucky enough health care programs; eliminating the cans. These new taxes are likely to sig- to be from one of the States, such as ability of insurance companies to deny nificantly hinder these engines of job the Cornhusker State or another State people insurance coverage because of growth. that got a special deal in this legisla- preexisting conditions; or eliminating Another troubling tax that will im- tion to get the Democratic leadership’s the caps that insurance companies put pact businesses in my State is the tax 60 votes, your Governor is going to be once an individual reaches a certain on device manufacturers. I have heard hit with a portion of the cost of ex- amount. from one of our Ohio companies that panding the Medicaid Program to cover Instead, we are going to pass a mas- this tax could force it to move its oper- all individuals up to 133 percent of the sive new spending bill that does little ations overseas to keep its doors open. Federal poverty level. to fix our problems in the long run. In fact—this is unbelievable—according In the State of Ohio, we have had What too many of my colleagues do not to the company’s own calculations, the 154,000 more people come on Medicaid understand is there are limits to what new device tax will exceed 100 percent just with the current extent of poverty, government can do. There are limits on of its domestic earnings and research and to go to 133 percent, it is going to what government can do. When I was and development budget. It has noth- be incredible. mayor of the city of Cleveland, Gov- ing to do with their profitability. They As a former Governor of Ohio, former ernor of Ohio, people would come to me say: You are this business. You have a chairman of the National Governors with ideas to expand programs and percentage of it, and we are going to Association, and past chairman of the services. Often, even though I saw the lay the tax right on your back. National League of Cities, I am very fa- merit of these proposals, just like I see Ohio cannot afford to lose these jobs miliar with what unfunded mandates the merit of a lot of the suggestions we to another country at any time but can do to State and local governments. need to have in terms of health care, I certainly not right now in this strug- By the way, there is a point of order knew we did not have the money to pay gling economy. But this is just the be- that lies against this bill as an un- for these proposals, especially because ginning for businesses, large and small. funded mandate in terms of local and

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I thank the Chair. primary and secondary education, to Russia, they are going to other Am I also correct that the Senate has higher education programs, roads and places to find those children, but here required a two-thirds cloture on bridges, county and local government in the United States over 40 million amendments to bills, where the amend- projects, and safety service programs abortions. Unfortunately, the language ments combine legislative provisions run by their States. In fact, I used to that was inserted in the managers’ and rules changes? I have a number of call Medicaid the Pacman that gobbled amendment does not protect taxpayer references to bills when this was done, up our State budget dollars. dollars from being used to fund abor- if there is any question, and I have So let’s look at this. You take the tion. In fact, the U.S. Conference of given them to the Parliamentarian for side over here of Medicaid, but then Catholic Bishops and National Right to consideration. Is there an answer? I what you do is you expand that, and it Life have said the language, and thus mean, I know there have been amend- is going to be more expensive, and then the bill, is unacceptable and should not ments to bills that we required two- you look around and you say: We have move forward. thirds because they include rule great needs with secondary and pri- Turning back to the fiscal arguments changes. I just wanted to get a con- mary education. The kids are com- against this bill, one of my colleagues firmation from our Parliamentarian. plaining about the fact that tuition is said yesterday that those of us on this Is that, in fact, the case, where two- going up for our institutions of higher side of the aisle who argue we cannot thirds cloture on amendments to bills education. Our local government offi- afford this bill are being disingenuous have been required to have a two-thirds vote because of the rules changes in- cials are complaining because the and we are engaging in scare tactics, cluded in them? State and local government funds that even asking when the ‘‘lying time’’— The PRESIDING OFFICER. The are going to them are not available to from a colleague on the other side—the Chair would have to check that for a them because all of this money is flow- ‘‘lying time’’ for this side of the aisle future answer. ing in this direction. In other words, will stop. Well, we will see. We will see. Mr. DEMINT. I believe the Parlia- under the Reid bill, we will put more I am not going to be a Member of the mentarian does have references for stress and further unfunded mandates U.S. Senate in 2012, but if God gives me when this has been done. I am quite on the States, making our health care the health and the energy, I will cer- certain it has. fiscal picture even worse than it would tainly be around to remind people who But as the Chair has confirmed, rule be without doing anything at all. This was telling the truth and who was not. XXII, paragraph 2, of the Standing doesn’t make any sense. Mr. President, I yield the floor. Rules of the Senate states that on a As I have often said—in fact, when I The PRESIDING OFFICER. The Sen- measure or motion to amend the Sen- was Governor, I said—Gone are the ator from South Carolina. ate rules, the necessary affirmative days when public officials will be Mr. DEMINT. I ask unanimous con- vote shall be two-thirds of the Senators judged by how much they spend on a sent to speak for 10 minutes. present and voting. problem; the new realities dictate that The PRESIDING OFFICER. Without Let me go to the bill before us be- we work harder and smarter and more objection, it is so ordered. cause buried deep within the over 2,000 with less. In fact, I remember giving Mr. DEMINT. Parliamentary inquiry, pages of this bill we find a rather sub- my state of the union addresses or Mr. President: stantial change to the Standing Rules state of the State addresses in Ohio, Does rule XXII of the Standing Rules of the Senate. It is section 3403, and it and they used to take a pool about how of the Senate provide that on a meas- begins on page 1,000 of the Reid sub- many times I would say ‘‘harder and ure or motion to amend the Senate stitute. These provisions not only smarter and more with less.’’ That is rules, the necessary affirmative vote amend certain rules, they waive cer- what our States are doing but not the shall be two-thirds of the Senators tain rules and create entirely new rules Federal Government—not the Federal present and voting? out of whole cloth. Government, oh, no. States are raising The PRESIDING OFFICER. It does. Again, I will skip over some exam- taxes and cutting but not the Federal Mr. DEMINT. Further parliamentary ples, but let me read a few of these pro- Government. We are just in there bor- inquiry: Is it also the case that on nu- visions that amend the Senate rules rowing and borrowing and borrowing as merous occasions, the Senate has re- which are contained in section 3403 of if there will be no tomorrow. quired a two-thirds cloture vote on the Reid substitute. The costs incurred by our children bills that combine amendments to the Section D titled ‘‘Referral:’’ and grandchildren as a result of this Senate rules with other legislative pro- The legislation introduced under this para- bill will be a crushing blow to their fu- visions that do not amend the rules? graph shall be referred by the Presiding Offi- tures—a future that is already ominous The PRESIDING OFFICER. That cers of the respective Houses to the Com- because of this body. In other words, would require a two-thirds vote. mittee on Finance in the Senate and to the what we are saying to them is we are Mr. DEMINT. I have numerous exam- Committee on Energy and Commerce and the putting the cost on their credit card. ples here. We did it twice this year on Committee on Ways and Means in the House of Representatives. You are in a new world where the S. 2349, and I could read those, but I competition is going to be keener than will spare the Chair all of these. I am The bill creates out of whole cloth a ever. We have all kinds of competitors just trying to get at a concern we have. new rule that this specific bill must be that we didn’t have when I was growing Am I correct that with respect to referred to the Senate Finance Com- up, so they are going to have to work these bills, there was a combination of mittee. Another example under section C, ti- harder. Then we are going to say to legislative provision and rules changes, tled ‘‘Committee Jurisdiction:’’ them: By the way, your taxes are going and the Chair ruled that because up. We are going to put a burden on there—and I am referring to earlier Notwithstanding rule 15 of the Standing Rules of the Senate, a committee amend- your back because we weren’t willing this year, those I referred to where we ment described in subparagraph (A) may in- to pay for or do without during the required the two-thirds cloture. Am I clude matter not within the jurisdiction of time we were in a position of responsi- correct on these previous bills that the Committee on Finance if that matter is bility. with respect to the bills, there was a relevant to a proposal contained in the bill Another legacy I am upset about combination of legislative provisions submitted under subsection (c)(3). leaving for our children and grand- and rules changes, and the Chair ruled Clearly a rule change. children is the public funding of abor- that because there were rules changes, So there is no pretense that this bill tion. The other day, I explained to an a two-thirds vote was required? is being referred under the rules to the

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LEGAL SERVICES CORPORATION FOR A TERM EXPIRING committee of jurisdiction. Now it is al- ate as a Senate rule, making it out of JULY 13, 2010, VICE FRANK B. STRICKLAND, TERM EX- lowing the Finance Committee to add order for Senators to propose amend- PIRED. VICTOR B. MADDOX, OF KENTUCKY, TO BE A MEMBER whatever matter it wants to the bill re- ments to repeal or amend it—I have OF THE BOARD OF DIRECTORS OF THE LEGAL SERVICES gardless of any rules regarding com- been in Congress 11 years. I have never CORPORATION FOR A TERM EXPIRING JULY 13, 2010, VICE mittee jurisdiction. And for a good heard of an amendment being called LILLIAN R. BEVIER, TERM EXPIRED. measure, the bill even specifically out of order because it changes some- IN THE AIR FORCE states that it is amending rule XV. thing that was done before. How is that THE FOLLOWING NAMED AIR NATIONAL GUARD OF THE UNITED STATES OFFICERS FOR APPOINTMENT TO THE Let me just skip over a number of different than the types of Senate rule- GRADE INDICATED IN THE RESERVE OF THE AIR FORCE other examples referring to rules just making for which our predecessors in UNDER TITLE 10, U.S.C., SECTIONS 12203 AND 12212: to try to get to the point here because their wisdom provided a two-thirds clo- To be colonel it goes on and on, and I have pages ture vote? This seems to be a redefini- FRANK R. AFLAGUE CHRISTOPHER R. ALDERDICE here. tion of words, in my mind. BORIS R. ARMSTRONG There is one provision that I found Mr. President, it is clear that the CLARENCE ATTERBURY III RICHARD T. BENNETT particularly troubling, and it is under Parliamentarian is going to redefine JOHN E. BLICKENSDERFER a section C titled ‘‘Limitation on words, as I am afraid he has done as GARY D. BREWER, JR. WILLIAM D. BUNCH Changes to This Subsection:’’ part of this process before. But this is JEFFREY W. BURKETT It shall not be in order in the Senate or in truly historic that we have included WADE K. CAUSEY JOSEPH S. CHISOLM the House of Representatives to consider any rules changes in legislation, and yet we JOHN L. CHURCH, JR. bill, resolution, amendment, or conference are ignoring a rule that requires a two- GREGORY S. CLAPPER report that would repeal or otherwise change SHAWN A. CLOUTHIER thirds cloture vote to pass it. I believe FRANK J. COPRIVNICAR, JR. this subsection. it is unconstitutional. I believe it sub- MICHAEL G. CRANSTON This is not legislation. This is not MARK A. CROSBY verts the principle we have operated THOMAS T. CURRY law. This is a rule change. It is a pretty under, and it is very obvious to anyone KEVIN S. DAILEY big deal. We will be passing a new law JOSEPH C. DARROW, JR. that it does change a rule. It is clear ELBURN H. DAUGHTRY III and at the same time creating a Senate that our rules mean nothing if we can CHARLES D. DAVIS III rule that makes it out of order to THOMAS C. ECHOLS redefine the words we use in them. REM B. EDWARDS III amend or even repeal the law. I am not I yield the floor. DAVID L. EVANS even sure it is constitutional, but if it BILLIE J. FAUST The PRESIDING OFFICER. The GREGORY P. FERNANDEZ is, it most certainly is a Senate rule. I Chair will note that it is quite common DAWN M. FERRELL don’t see why the majority party JAMES C. FOGLE to include provisions affecting Senate TROY A. FROST wouldn’t put this in every bill. If you procedure in legislation. WALTER E. GARTNER like your law, you most certainly MICHELE M. GAVIN Mr. DEMINT. Is there a difference be- PETER T. GELESKIE would want it to have force for future JASON W. GLASS tween Senate procedures and rules? Senates. I mean, we want to bind fu- PETER T. GREEN III The PRESIDING OFFICER. Yes THOMAS E. HANS ture Congresses. DOUGLAS D. HAYWORTH Mr. DEMINT. So the language you This goes to the fundamental purpose PAUL F. HEYE, JR. see in this bill that specifically refers MICHAEL C. HIRST of Senate rules, to prevent a tyrannical GEORGE W. HOLT, JR. to a change in a rule is not a rule CASSANDRA D. HOWARD majority from trampling on the rights change, it is a procedure change? JEFFREY W. JACOBSON of the minority or of future Congresses. WENDY K. JOHNSON Therefore, I would like to propound a The PRESIDING OFFICER. That is MARQUITA P. JOHNSONBAILEY correct. JEFFRY J. JORDAN parliamentary inquiry to the Chair. RICHARD J. KEASEY Does section 3403 of this bill propose Mr. DEMINT. Then I guess our rules JOHN R. KIRK mean nothing, do they, if we can rede- THADDEUS J. KOLWICZ amendments to the Standing Rules of MEAGHAN Q. LECLERC the Senate? Further parliamentary in- fine them. SUZANNE B. LIPCAMAN I thank the Chair. I yield the floor. SANDRA D. LONG quiry: Does the inclusion of these pro- RONALD D. LOWERY MARK S. LYON posed amendments to the Senate rules f MARK J. MACLEAN mean that the bill requires two-thirds CRAIG A. MANIFOLD ADJOURNMENT UNTIL 7 A.M. MICHAEL E. MANNING present and voting to invoke cloture? TOMORROW ROBERT S. MARTIN The PRESIDING OFFICER. The sec- JOE A. MARTINEZ II The PRESIDING OFFICER. The Sen- JAMES P. MOFFETT tion of the proposed legislation ad- MARK D. MURPHY dressed by the Senator does not amend ate stands adjourned until 7 a.m. to- STEVEN S. NORDHAUS morrow. TIMOTHY P. OBRIEN the Standing Rules of the Senate, and LOUISE M. PARADIS therefore its inclusion does not affect Thereupon, the Senate, at 7:41 p.m., LOUIS J. PERINO adjourned until Tuesday, December 22, WILLIAM R. POST the number of votes required to invoke JOSEPH S. ROBINSON cloture. 2009, at 7 a.m. WILLIAM D. ROGERS, JR. JON L. SCOTT Mr. DEMINT. Is the Chair aware of f EDWIN B. SELF, JR. any precedent where the Senate cre- RAY M. SHEPARD NOMINATIONS RICHARD I. SIMMONS ated a law and in doing so created a JOHN D. SLOCUM new rule that—and I am quoting from Executive nominations received by TIMOTHY G. SMITH STANLEY U. SNOW our bill: the Senate: SEAN M. SOUTHWORTH It shall not be in order in the Senate or in DEPARTMENT OF HOUSING AND URBAN MICHAEL D. STOHLER JEFFREY D. STOREY the House of Representatives to consider any DEVELOPMENT STEPHEN L. SUAFILO STEVEN R. SWETNAM bill, resolution, amendment, or conference THEODORE W. TOZER, OF OHIO, TO BE PRESIDENT, GOV- JAMES D. TAYLOR II ERNMENT NATIONAL MORTGAGE ASSOCIATION, VICE JO- report that would repeal or otherwise WILLIAM L. THOMAS SEPH J. MURIN, RESIGNED. change— TAMI S. THOMPSON DEPARTMENT OF COMMERCE CHRISTOPHER K. THOMSON Such law? RANDALL TOM Is the Chair aware that we have ever KEVIN WOLF, OF VIRGINIA, TO BE AN ASSISTANT SEC- JEFFREY R. VALLE RETARY OF COMMERCE, VICE CHRISTOPHER R. WALL, JEFFREY J. WAECHTER put this type of binding legislation on RESIGNED. CHRISTOPHER S. WALKER future Congresses in a bill? TIMOTHY MCGEE, OF LOUISIANA, TO BE AN ASSISTANT JOSEPH G. WALSH IV The PRESIDING OFFICER. It is SECRETARY OF COMMERCE, VICE PHILLIP A. RODNEY WILLIAMS SINGERMAN. JOSEPH B. WILSON quite common to do that. FRANK Y. YANG LEGAL SERVICES CORPORATION Mr. DEMINT. I would ask the Chair WILLIAM T. YATES SHARON L. BROWNE, OF CALIFORNIA, TO BE A MEMBER IN THE MARINE CORPS to get those references, if the Parlia- OF THE BOARD OF DIRECTORS OF THE LEGAL SERVICES mentarian would, to us. CORPORATION FOR A TERM EXPIRING JULY 13 , 2010, VICE THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT Mr. President, another parliamen- MICHAEL MCKAY, TERM EXPIRED. TO THE GRADE INDICATED IN THE UNITED STATES MA- CHARLES NORMAN WILTSE KECKLER, OF VIRGINIA, TO RINE CORPS RESERVE UNDER TITLE 10, U.S.C., SECTION tary inquiry: If this new law will oper- BE A MEMBER OF THE BOARD OF DIRECTORS OF THE 12203:

VerDate Mar 15 2010 09:19 Nov 08, 2012 Jkt 079102 PO 00000 Frm 00073 Fmt 0686 Sfmt 9801 E:\BR09\S21DE9.002 S21DE9 wreier-aviles on DSK5TPTVN1PROD with December 21, 2009 CONGRESSIONAL RECORD—SENATE, Vol. 155, Pt. 24 32979 To be colonel BRIAN J. BRAUER MARK A. FERGUSON KEITH C. BRENIZE CHARLES P. FERRER DAVID F. ALLEN KEVIN D. BRIGGS CHAD R. FITZGERALD MICHAEL T. BARRY ADAM W. BRILL DANIEL S. FITZPATRICK WILLIAM M. BROWN, JR. KATALIN C. BROGDON JAMES P. FLASS JAMES BURACK MATTHEW R. BROWER BRADLEY G. FLURRY ANTONIO J. CAPETILLO KEVIN M. BROWN JASON T. FORD DAVID H. CLEARY MATTHEW J. BROWN TYLER R. FOTHERINGILL BRUCE M. DOWNS PETER E. BROWN DANIEL B. FRANCIS BARRY E. FEDERICI KYLE A. BUCHINA JOHN J. FRANKLIN THOMAS P. FORT ROBERT S. BUNN JENNIFER A. FREDERICKSEN MICHAEL J. FROEDER CHRISTOPHER M. BURNETT BRIAN E. FRIESTMAN JAMES H. GRIFFIN EUGENE E. BURRELL, JR. GREGORY T. FUNK DAVID A. GRUSS KYLE R. BUSH DANIEL R. GABLE CHRISTOPHER N. HAMILTON JOHN M. BUSSARD KURT M. GALL JOHN S. HOGAN JARED E. CAGLE SCOTT P. GALLAGHER THADDEUS L. JANKOWSKI STANLEY P. CALIXTE MEREDITH E. GALVIN TREVOR E. KLEINEAHLBRANDT GEORGE D. CAMIA JAVIER A. GARCIA JOHN C. KRIZAN TOMMASO CAMILLERI FRANCIS F. GARNER JOHN H. LISTER IAN S. CAMPBELL JANINE K. GARNER JAMES C. MCDONALD CESAREON E. CARAMANZANA MICHAEL S. GARRISON WILLIAM M. MCGOWAN REGINA V. CARBONARI SERGIO A. GARZA PHILLIP A. MILLERD MICHAL CARLSON MARIO J. GASCA WILLIAM F. MORGAN MANUEL F. CARPIO AARON M. GATES MARK G. MURPHY MICHAEL J. CARROLL STEPHEN G. GAUGLER MATTHEW D. NAFUS CHRISTOPHER B. CARTER RYAN M. GEER WILLIAM S. NAGLE, JR. CHRISTOPHER T. CASEY ERIC P. GENTRUP JACQUES C. NAVIAUX II ROBERT D. CASILLAS ERIC L. GEYER JOHN G. NETTLES MICHAEL R. CASSIDY JASON R. GIBBS STEPHEN B. NICHOLS JOSHUA E. CAVAN JOHN F. GIBSON JAMES L. PARKER BOLO S. CAVANH SETH F. GIBSON DAVID L. POHLMAN GREER C. CHAMBLESS CRAIG A. GIORGIS DANIEL J. REBER MICHAEL K. CHANKIJ JOSHUA GIRTON JOSEPH K. RILEY ROBERT F. CHAPELL JONATHAN P. GLASS EMILIO T. ROVIRA SHAWN M. CHARCHAN JOSHUA L. GLOVER DWIGHT C. SCHMIDT DAVID P. CHEEK DANIEL V. GOFF JOHN A. SKINNER TOM CHHABRA DANIEL R. GOHLKE WARREN J. SOONG RONALD G. CHINO SETH P. GOLDSTEIN JOSEPH M. STUART, JR. ERIC W. CHRISTENSON MARK S. GOMBO ERIC M. VEIT BRIAN P. CHRISTIANSON CARLOS E. GONZALEZDAVILA MICHAEL A. WABREK ALAN J. CLARKE GREGORY D. GOOBER JAMES L. WATSON, JR. STEVEN M. CLIFTON ANDREA C. GOODE MARVIN A. WILLIAMS DANNY J. COHLMEYER MARVIN D. GOODWIN RAYMOND S. COLLINS CHRISTOPHER R. GORDON THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT STACEY B. COLON WILLIAM V. GORSUCH TO THE GRADE INDICATED IN THE UNITED STATES MA- KEVIN T. CONLON JABBAR R. GOUGHNOUR RINE CORPS UNDER TITLE 10, U.S.C., SECTION 624: CHRISTOPHER S. CONNER ANDREW G. GOURGOUMIS To be major TRUSTUN G. CONNOR ANTHONY J. GRABICKI SCOTT A. CONSTANTINEAU THOMAS J. GRACE JOSE M. ACEVEDO JESSE B. COOK MICHEAL R. GRAHAM DAVID AHN NEIL A. CORDES BENJAMIN W. GRANT DARRIAN H. AINSWORTH TIMOTHY F. COSTELLO ROBERT C. GRASS CHRISTOPHER P. ALLAIN LUKE A. COYLE CHRISTOPHER G. GRASSO DARREN G. ALLISON JASON A. CRAIG BRYAN K. GRAYSON NAIM I. ALQAADIR WILFREDO CRAVE, JR. ERIC D. GREGORY CHAD J. ALTHISER CHAD E. CRAVEN JOSEPH I. GRIMM TIMOTHY D. ANDERLONIS TAMERSEN J. CRITCHLOWGLENN DAVID M. GROSSO MICHAEL R. ANDERSON WALTER D. CROMER, JR. JEFF D. GROVES SHAWN E. ANDERSON VICTOR M. CRUZ JOHN E. GRUNKE KIELLY A. ANDREWS CARLOS R. CUEVAS ABEL J. GUILLEN JOSEPH F. ANDROSKI SAMUEL C. CUNNINGHAM JOHN D. GWAZDAUSKAS CHRISTOPHER E. ANNUNZIATA SCOTT A. CUOMO BRIAN L. HAAN MICHAEL ANTHONY, JR. JEFFREY S. CURTIS JEFFREY P. HAAS ZACHARIAH E. ANTHONY MARC R. DAIGLER AARON R. HAINES JOEL R. ARCHIBALD MATTHEW T. DAIGNEAULT CHRISTOPHER G. HAKOLA JUSTIN M. ARGENTIERI JOSEPH P. DAMICO MATTHEW E. HALBERT SARAH B. ARMSTRONG BRIAN R. DAVIS JUSTIN J. HALL MARC F. ARNOLD EVAN A. DAY CHAD P. HAMILTON JOSEPH A. ATKINSON LANCE C. DAY MARK A. HAMILTON JOSHUA P. BAHR WESLEY J. DEAVER BRENT A. HAMPTON COLIN F. BAILEY JEREMY R. DELBOS ROBERT S. HARGATE DOUGLAS A. BAKER ARLAN M. DELLA PAUL W. HARRIS II NATHANIEL A. BAKER CHRISTOPHER D. DELLOW RUSSELL D. HARRIS PETER Y. BAN KENNETH J. DELMAZO SCOTT W. HARRIS JAMES H. BANTON, JR. CHRISTOPHER G. DEMETRIADES TRACEY L. HARTLEY RICHARD S. BARCLAY TERA D. DENIAL CHRISTOPHER B. HAUGHTON JAMES K. BARE, JR. LAUREN K. DIANA BRADLEY J. HAUSMANN DONALD J. BARNES MICHAEL J. DIGANGI CARL A. HAVENS RYAN D. BARNES NATHANIEL P. DOHERTY BRIAN M. HAWKINS RICARDO A. BARTON JAMES P. DOLLARD ROGER W. HEAD, JR. DANIEL M. BARTOS DWAIN A. DONALDSON II RYAN R. HEISINGER KATHARINE A. BARWICK BRIAN C. DONNELLY THOMAS J. HELLER JOSHUA R. BATES KIRK D. DOOLEY RUSSELL R. HENRY LONNIE A. BAXLEY DANIEL M. DOWD JASON E. HERNANDEZ JOHN R. BEAL MATTHEW S. DOWNS ROBERT E. HERRMANN HOWARD G. BEASEY ROY M. DRAA MARCUS A. HINCKLEY MICHAEL S. BEASLEY GERMAN E. DUARTE MICHAEL T. HLAD ZEB B. BEASLEY II BRAD M. DUBINSKY GEOFFREY L. HOEY RICHARD T. BEESON SHARON L. DUBOW NATHAN F. HOFF JOHN M. BEICHNER, JR. SHANE C. DUFFLE DAVID B. HOLDSTEIN DAVID M. BELL DAMIAN J. DUHON KENNETH B. HOLLINGER SCOTT M. BENNINGHOFF TYSON W. DUNKELBERGER THOMAS M. HOLLMAN RYAN P. BENSON DUANE A. DURANT PAUL J. HOLST JOHN L. BERAUD ROBERT B. DYER JOHN K. HOOD NEIL R. BERRY GARRETT C. EBEY ANGELA R. HOOPER BART A. BETIK SHANE A. EDWARDS RANDY D. HOOPER NICHOLAS J. BEZANSON WILBURT A. ELLIOTT CHRISTOPHER M. HOOVER KEVIN M. BICKING DEREK I. EMERY SARA E. HOPE JOSHUA P. BIGGERS ANDREW J. ERICKSON CHRISTOPHER R. HORTON JAMES C. BISE PAUL M. ERVASTI TERRY W. HORTON, JR. ALVIN C. BISSETTE ALBERT G. ESKALIS CLINT A. HOUCHINS PAUL B. BISULCA LUKE T. ESPOSITO MATTHEW W. HOWARD JOHN R. BITONTI II TERRY R. EVANS DANIEL E. HUGHES ADAM W. BLANTON BENJAMIN D. EVERETT DAVID W. HUGHES KENDALL J. BODNAR LUKE L. FABIUNKE TIMOTHY J. HUMPHREYS MICHAEL J. BORNEO ROBERTO C. FALCON JOHN M. HUNT WILLIAM M. BOULWARE NATHAN D. FAUGHT SEAN M. HURLEY DAVID J. BOWER STEVEN M. FAYED MICHAEL W. HUTCHINGS ROBERT R. BOYCE ETHAN R. FEATHERLY CALEB HYATT DOUGLAS R. BOYLE RALPH L. FEATHERSTONE JASON M. IVERSEN TIMOTHY F. BRADY, JR. RAYMOND P. FELTHAM EMILY A. JACKSONHALL MARK P. BRAITHWAITE MARK R. FENWICK LUKE J. JACOBS

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AMY J. JAMES MICHAEL L. MEYERS JASON W. ROOKER GRACE K. JANOSEK JASON W. MILBRANDT SAMUEL ROSALES SHANE B. JENSON MATTHEW T. MILBURN JAMES T. ROSE BROOK K. JERUE DAVID E. MILLER JOSHUA T. ROSE ROBERT J. JOHNESSEE MICAH M. MILLER DANIEL H. ROSENBERG CHRISTOPHER C. JOHNSON PATRICK A. MILLER SHANE R. ROSENTHAL MELISSA J. JOHNSON RYAN L. MILLER MICHAEL H. ROUNTREE, JR. COURTNEY A. JONES ERICK MIN IAN H. ROWE ELI J. JONES ROY L. MINER DANNY ROZEK ERIC T. JONES KEYSTELLA R. MITCHELL AMY B. ROZNOWSKI GEORGE L. JONES, JR. TONY M. MITCHELL CHRISTOPHER J. ROZSYPAL JASON R. JONES BRENT S. MOLASKI TARA A. RUSSELL JOHN D. JORDAN MICHAEL V. MONETTE THOMAS J. RYAN EDWARD J. JORGE ADAM S. MONTEFORTE FRANKLIN V. SABLAN DAVID L. JUPITER SCOTT J. MONTGOMERY MATEO E. SALAS MICHAEL D. KANIUK JAMES M. MOORE RUDY G. SALCIDO STEPHAN P. KARABIN II JAMES M. MOORE, JR. MARK D. SAMEIT KENNETH M. KARCHER JOHN T. MOORE GREGORY A. SAND II MATTHEW B. KAVE NATHAN O. MORALES ERIC A. SANDBERG JEFFREY P. KEATING RICARDO R. MORENO AARON D. SANDERS RALPH O. KEENER, JR. DANICA J. MOTTOLA THOMAS W. SAVAGE NICHOLAS J. KELLER JOSHUA P. MOUNTAIN RUSSELL W. SAVATT IV ANDREW W. KELLNER KATE L. MURRAY RICCARDO D. SCALISE JOHN F. KELLY MATTHEW MURRAY JASON S. SCHERMERHORN TIMOTHY E. KENT MICHAEL W. MURRAY KENNETH W. SCHOONOVER PATRICK C. KEPLINGER MIKEAL S. MURRAY MATTHEW P. SCHROER THOMAS W. KERSHUL NICHOLAS R. NAPPI MATTHEW T. SCOTT BRYAN L. KILL KIMBERLY A. NARVID TIMOTHY J. SCOTT SUSAN M. KILPATRICK DAVID S. NASCA CHRISTOPHER R. SEIGH ANDREW J. KINGSBURY GLEN E. NEISES PATRICK J. SEIPEL JOHN S. KINITZ CHARLES D. NICOL, JR. PETRA L. SEIPEL JOSHUA S. KIRK DAVID C. NICOL JOE A. SERVIN ROBERT A. KLEINPASTE JOSE A. NICOLAS OSCAR V. SESSOMS IV MICHAEL W. KNAPP CHRIS P. NIEDZIOCHA ROBERT S. SHEARER CHRISTOPHER T. KOCAB MARK A. NOBLE SCOTT A. SHIDELER ERICK G. KOOB ANDREW J. NORRIS THOMAS P. SHIELDS TY B. KOPKE JOSHUA J. NORRIS DERRICK SIMMONS MARCUS H. KRAUSS DAVID S. NOWLIN THOMAS P. SIMS DOUGLAS P. KRUGMAN LISA M. OBRIEN ERIC J. SJOBERG DAEYONG M. KU MATTHEW R. OHARA MICHAEL B. SLATT JASON K. KURZ ELIZABETH A. OKOREEHBAAH CHRISTOPHER T. SMITH ALEXANDER T. KUSHNIR ERIC M. OLSON MICHAEL F. SMITH JASON B. LADD JAHN C. OLSON OWEN A. SMITH TERESA N. LAKE DANIEL J. OREILLY RANDALL D. SMITH DARRYL P. LAMBERTH BRIAN J. OSHEA VICENTE A. SMITH ERIC M. LANDBLOM JEB A. OUTTRIM CRAIG R. SNOW LERON E. LANE TERRY D. PARCHMAN JARED M. SNOW JENNIFER L. LARSEN CHARLES E. PARKER, JR. DEREK J. SNYDER MATTHEW P. LAVALLEE RANDALL L. PARKER EDWARD T. SOLEY, JR. ERIC LECKIE DANIEL L. PARROTT, JR. DAVID J. SON DAVID J. LEE, JR. JIEMAR A. PATACSIL CHINPASSEU SONETHAVILAY JASON T. LEIGH JEFFREY B. PATTAY ANTHONY G. SOUSA DAVID C. LEMKE TRAVIS L. PATTERSON PATRICK S. SPENCER AARON D. LENZ FERDINAND P. PECHE BRENT W. SPOOR ROBERT A. LEONARD IAIN D. PEDDEN JOHN W. SPORTSMAN WARREN LEONG JAMES L. PELLAND PHILLIP K. SPRINCIN MICHAEL LEPORE JOHN W. PELZER MATTHEW A. SPROAT MARC E. LEWIS OMAR N. PERALTA, JR. PAUL E. STANKEVICH WILLIAM B. LEWIS JOSE J. PEREIRA DAVID R. STARK MICHAEL D. LIBRETTO KEITH M. PETERSON KRISTOFOR W. STARK CRAIG H. LIGUORI BRADY P. PETRILLO ROBERT P. STCROIX, JR. CHRISTOPHER S. LITTY DUY T. PHAM BRIAN J. STEPHENSON TODD H. LITVIN ELIZABETH PHAM DOUGLAS R. STEVENS MICHAEL J. LORINO SHAWN M. PHILLIPS JOHN M. STEVENS DANIEL F. LOUGHRY BRADLEY A. PIERCE ROBERT N. STONAKER DAVID A. LOUIE LAWRENCE V. PION III RUSSELL A. STRANGE JASON D. LOVELL NUNO M. PIRES SCOTT T. STURROCK ERIK G. LOYA NICHOLAS M. POMARO WALTER SUAREZ MICHELLE I. MACANDER DAVID W. POPE JEREMY L. SULLIVAN WALTER A. MAESSEN III JACOB D. PORTARO JUNWEI SUN RICHARD S. MAIDENS ROBERT J. PORTER NATHAN E. SWIFT ADAN C. MALDONADO MATTHEW M. POWERS ROBERT J. TART AMY E. MALUGANI MICHAEL V. PRATO CHRISTOPHER A. TAYLOR ARTURO MANZANEDO JOHN V. PRICEVANCLEVE ROBERT L. TAYLOR, JR. WILLIAM E. MARCANTEL, JR. LUKE J. PRIGG RONELLA P. TAYLOR JOSEPH K. MARKEL CARL J. PUNZEL ROY L. TAYLOR, JR. PAUL J. MARKO JIM J. PUREKAL ARTHUR R. TERRY II SEAN K. MARLAND KERRY R. QUINBY KHALILAH M. THOMAS CLINT R. MARSHALL ALEJANDRO D. QUINN DANIEL W. THOMPSON ZACHARY D. MARTIN MARTY L. RADDIGAN MARK A. THOMPSON CARL B. MARTINEZ ZACHARY J. RASHMAN STEVEN R. THOMPSON RACHEL A. MATTHES BILLY J. RATLIFF, JR. JAMES D. THORNBURG, JR. BRIAN D. MAURER PHILIP M. RAYMOND JUANMICHAE G. TIJERINA STEVEN D. MAYS ANTHONY J. RAYOME GORDON L. TOPPER JOSEPH S. MCALARNEN BENJAMIN M. READ JAMES S. TOPPING MATTHEW A. MCBRIDE WADE C. REAVES ANGEL M. TORRES TREY M. MCBRIDE JASON B. REED PABLO J. TORRES JEFFREY V. MCCARTHY FOREST J. REES III JAMES H. TRAYLOR, JR. JOHN M. MCCLENDON JUSTIN E. REETZ BRIAN K. TRIEVEL ADAM C. MCCULLY JACOB S. REEVES THOMAS N. TRIMBLE CHRISTOPHER C. MCDONALD II JAMES B. REID JOSEPH P. TROYAN III ROBB T. MCDONALD MATTHEW D. REIS ANASTASIOS TSOUTIS MICHAEL S. MCDOWELL LISA J. REUTER ERIK K. TYLER THOMAS R. MCGOLDRICK LETICIA REYES WILLIAM L. TYREE, JR. WILSON R. MCGRAW FRANK B. RHOBOTHAM IV SHAWN D. TYSON DANIEL P. MCGUIRE STACEY W. RHODY PAUL S. UMBRELL MICHAEL D. MCGURREN NATHAN A. RICE PAMELA N. UNGER PATRICK A. MCKINLEY PHILLIP N. RICHARDS JACOB C. URBAN WILLIAM R. MCLEAREN KATHIA E. RIVAS DAVID A. VALENTINO CHRISTOPHER D. MCLIN JEFFREY M. ROBB MATTHEW A. VANECHO WAYNE A. MCMILLAN KENT A. ROBBINS, JR. JORDAN W. VANNATTER MICHAEL C. MCVICKER MICHAEL S. ROBERTS MICHAEL C. VASQUEZ RICHARD G. MCWILLIAMS SEAN F. ROBERTSON BLAKE E. VEATH CHRISTOPHER D. MEIXELL RICHARD H. ROBINSON III SIDDHARTHA M. VELANDY MADELINE M. MELENDEZ SHAWN T. ROBINSON JACOB P. VENEMA SEAN M. MELLON TIMOTHY J. ROBINSON BRIAN R. VONKRAUS CHRISTOPHER M. MERCER FELIX A. RODRIGUEZ JOHN P. VOORHEES ROBERT D. MERRILL, JR. OSCAR E. RODRIGUEZ, JR. ROBERT S. VUOLO DAVID A. MERRITT GERALD W. ROEDER, JR. ARMIN H. WAHL ROBYN E. MESTEMACHER JAYMES E. ROEDL NICHOLAS D. WALDRON JAMES R. MEYER ALEXANDER T. ROLOFF EARLIE H. WALKER, JR. MICHAEL T. MEYER JOHN J. ROMA MARC T. WALKER

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COURTNEY E. WALSH RUSSELL P. WIER MATTHEW D. WOODS KEVIN C. WALSH MICHAEL J. WILDAUER ADAM J. WORKMAN WILLIAM T. WALSH TREVOR A. WILK LUKE R. WRIGHT ROBIN J. WALTHER ERIC L. WILKERSON TIMOTHY D. WRIGHT ASA C. WARRINGTON RICHARD T. WILKERSON KEO S. YANG NICHOLAS G. WEBB CORBIN T. WILLIAMSON BEATRIZ YARRISH SCOTT M. WEINPEL JAMES H. WILLIAMSON JEREMY R. YAUCK TONY J. WEIR JOSEPH M. WILLS ELGIN D. YOUNG II RYAN J. WEISHEYER CARLTON A. WILSON SCOTT D. WELBORN BRADLEY J. WIMSATT MARCUS L. YOUNG JOSHUA O. WHAMOND HUGH O. WINGATE FRANCISCO X. ZAVALA CHRISTOPHER S. WHITE ADAM J. WINSLOW CARL L. ZEPPEGNO RONALD WHITE, JR. BRIAN M. WLOCH CHAD W. ZIMMERMAN EDWIN J. WHITEMAN ROBERT D. WOLFE

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SENATE COMMITTEE MEETINGS on Monday and Wednesday of each amend the Hate Crime Statistics Act Title IV of Senate Resolution 4, week. to include crimes against the homeless, Meetings scheduled for Tuesday, De- S. 1554, to amend the Juvenile Justice agreed to by the Senate on February 4, and Delinquency Prevention Act of 1974 cember 22, 2009 may be found in the 1977, calls for establishment of a sys- to prevent later delinquency and im- tem for a computerized schedule of all Daily Digest of today’s RECORD. prove the health and well-being of mal- meetings and hearings of Senate com- treated infants and toddlers through mittees, subcommittees, joint commit- MEETINGS SCHEDULED the development of local Court Teams tees, and committees of conference. DECEMBER 24 for Maltreated Infants and Toddlers This title requires all such committees 10 a.m. and the creation of a National Court to notify the Office of the Senate Daily Judiciary Teams Resource Center to assist such Digest—designated by the Rules Com- Business meeting to consider S. 714, to Court Teams, S. 1789, to restore fair- mittee—of the time, place, and purpose establish the National Criminal Justice ness to Federal cocaine sentencing, of the meetings, when scheduled, and Commission, S. 1624, to amend title 11 H.R. 1741, to require the Attorney Gen- any cancellations or changes in the of the United States Code, to provide eral to make competitive grants to eli- meetings as they occur. protection for medical debt home- gible State, tribal, and local govern- As an additional procedure along owners, to restore bankruptcy protec- ments to establish and maintain cer- tions for individuals experiencing eco- tain protection and witness assistance with the computerization of this infor- nomic distress as caregivers to ill, in- programs, and the nomination of O. mation, the Office of the Senate Daily jured, or disabled family members, and Rogeriee Thompson, of Rhode Island, Digest will prepare this information for to exempt from means testing debtors to be United States Circuit Judge for printing in the Extensions of Remarks whose financial problems were caused the First Circuit. section of the CONGRESSIONAL RECORD by serious medical problems, S. 1765, to SD–226

● This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor.

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